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Prior Authorization Forms
The Optum Rx Prior Authorization Request Form is used when the provider requests consideration on behalf of an AHCCCS Fee-For-Service (FFS) recipient for a drug
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Prescription Drug Coverage
Print and complete the Optum Rx Prescription Reimbursement Form [PDF] to submit a claim from an out-of-network pharmacy. Should you have any questions
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June 2021 Provider Bulletin
Jun 15, 2021 Optum may request medical records to validate if hydration was one fax (833) 322-1061. As a reminder, a PA Request Form with all pertinent
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