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OPTIMA HEALTH COMMUNITY CARE
AND
OPTIMA FAMILY CARE
(MEDICAID)
PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST*
Directions: The prescribing physician must sign and clearly print name (preprinted stamps
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How to fill out optima health community care
How to fill out optima health community care
01
To fill out Optima Health Community Care, you need to follow these steps:
02
Obtain the application form from the Optima Health website or call their customer service.
03
Provide your personal information, such as your name, address, date of birth, and contact details.
04
Fill out the section related to your current health insurance coverage, if applicable.
05
Disclose any pre-existing medical conditions or chronic illnesses that you have.
06
Provide information about your income and employment status.
07
Include any other supporting documents required, such as proof of income or identification.
08
Review the completed form for any errors or missing information.
09
Sign and date the application form.
10
Submit the filled-out form either online, by mail, or in person at an Optima Health office.
11
Wait for a confirmation or response from Optima Health regarding your application.
Who needs optima health community care?
01
Optima Health Community Care is designed for individuals who:
02
- Are eligible for Medicaid or Medicare
03
- Have low income
04
- Have no or limited access to other healthcare options
05
- Require comprehensive healthcare services
06
- Want to receive care from a network of healthcare providers affiliated with Optima Health
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What is optima health community care?
Optima Health Community Care is a managed care Medicaid health plan.
Who is required to file optima health community care?
Healthcare providers who participate in the Optima Health Community Care network are required to file.
How to fill out optima health community care?
Optima Health Community Care forms can be filled out online or submitted by mail.
What is the purpose of optima health community care?
The purpose of Optima Health Community Care is to provide Medicaid recipients with access to quality healthcare services.
What information must be reported on optima health community care?
Information such as patient demographics, medical services provided, and billing details must be reported on Optima Health Community Care forms.
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