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Please note: All information below is required to process this request Mon Fri: 5am to10pm Pacific / Sat: 6am to 3pm Pacific For real time submission 24/7 visit www.OptumRx.com and click Health Care

How to fill out prior authorization request form

How to fill out prior authorization request form

1. To fill out a prior authorization request form, follow these steps: 1. Obtain a copy of the prior authorization request form from your healthcare provider or insurance company.
2. Read through the form carefully to familiarize yourself with the required information.
3. Start by providing your personal details, such as your name, contact information, and insurance policy number.
4. Identify the specific medical service, medication, or treatment that requires prior authorization.
5. Provide all relevant medical information, including the diagnosis, medical history, and any supporting documentation.
6. If applicable, attach any additional documents required to support the request, such as medical records or test results.
7. Fill out the section related to your healthcare provider, including their name, contact information, and professional credentials.
8. Review the completed form for accuracy, ensuring all required fields are filled and all supporting documents are attached.
9. Submit the form to your healthcare provider or insurance company through the designated method, such as mail, fax, or online portal.
10. Keep a copy of the filled-out form for your records and follow up with your healthcare provider or insurance company for updates on the status of your request.

Who needs prior authorization request form?

1. Anyone who wishes to receive a healthcare service, medication, or treatment that requires prior authorization from their insurance company needs to fill out the prior authorization request form.
2. This includes patients, healthcare providers, and pharmacies who need to obtain permission from the insurance company before proceeding with a specific medical service, medication, or treatment.
3. Prior authorization is typically required for procedures or medications that are deemed expensive, require special approval, or have alternative treatment options available.
4. Each insurance company may have its own specific criteria and guidelines for when prior authorization is necessary.

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