Optumrx prior authorization form 2025

Get Form
18007114555 Preview on Page 1

Here's how it works

01. Edit your 18007114555 online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send 800 711 4555 via email, link, or fax. You can also download it, export it or print it out.

The best way to modify Optumrx prior authorization form online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

With DocHub, making adjustments to your documentation requires only a few simple clicks. Make these fast steps to modify the PDF Optumrx prior authorization form online free of charge:

  1. Sign up and log in to your account. Sign in to the editor with your credentials or click Create free account to evaluate the tool’s features.
  2. Add the Optumrx prior authorization form for redacting. Click the New Document option above, then drag and drop the file to the upload area, import it from the cloud, or via a link.
  3. Change your file. Make any adjustments required: add text and pictures to your Optumrx prior authorization form, highlight important details, erase sections of content and substitute them with new ones, and insert symbols, checkmarks, and fields for filling out.
  4. Finish redacting the template. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and efficient. Give it a try now!

be ready to get more

Complete this form in 5 minutes or less

Get form

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.
Contact us
To submit these requests, please contact our PA department at 1-800-711-4555.
Getting a prescription filled Writing a paper prescription that you take to a local pharmacy. Calling or faxing a pharmacy to order the medicine. Sending your prescription to the pharmacy by way of a computer that is linked to the providers electronic medical record (EMR)
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.
(OptumRx Mail Service) 6800 W 115th St, Suite 600 Overland Park, KS 66211-9838 NCPDP: 1718634 Call 1-800-791-7658 Provide a verbal prescription directly to an Optum Rx provider dedicated pharmacist. Fax 1-800-491-7997 Send a complete prescription using the Physician Fax Form.
Except under certain circumstances, the law requires all prescriptions to be issued electronically, pursuant to Business and Professions Code section 688.
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

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 do I fill a new prescription? Fill out an order form. Write the member ID number, patient name and patient date of birth on the back of each prescription. Mail the form to OptumRx.

optum rx prior auth form