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Emgality Prior Authorization Request Form - OptumRx

Emgality Prior Authorization Request Form - OptumRx 2025

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4.9 out of 5

42 votes

Optum Rx has collaborated with CoverMyMeds to streamline the prior authorization process for medications, specifically Xarelto®, allowing for quicker and often real-time determinations. The document includes a detailed request form that requires specific member and provider information, medication details, and clinical history. It emphasizes the importance of providing complete information to avoid denial of requests and outlines contact details for urgent requests.

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Versions	Form popularity	Fillable & printable
2017	4.9 Satisfied (42 Votes)
2014	4.5 Satisfied (39 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I appeal Optumrx prior authorization?

Yes, you can appeal the decision. Your provider will need to fax a letter of medical necessity to: Managed Pharmacy Consultations at 561-209-5822. The appeal review takes about 24-48 hours. After 48 hours, members can call Optum Rx at 866-441-2422 to check the status.

How do I complete a prior authorization?

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.

How do I request prior authorization on OptumRx?

Submitting a PA request to OptumRx via phone or fax above. For urgent requests, please call us at 1-800-711-4555. (Hours: 5am PST to 10pm PST, Monday through Friday.)

How to appeal prior authorization rejection?

You may also file an appeal if your health plan denies pre-approval (called prior authorization) for a benefit or service. There are two types of appealsan internal appeal and an external review. You file an internal appeal to ask your health plan to review its decision to deny a claim.