Optumrx form 2025

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The document is a Prior Authorization Request Form for the medications Provigil® and Nuvigil®, requiring detailed member and provider information, medication details, and clinical information related to various sleep disorders. It outlines necessary questions for diagnosis confirmation, reauthorization criteria, and additional comments needed for processing the request. The form emphasizes the importance of safeguarding protected health information (PHI) and provides contact information for urgent requests.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (176 Votes)
2015	4 Satisfied (46 Votes)
2014	4.4 Satisfied (608 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 send my prescription to OptumRx?

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)

How do I submit a prescription to OptumRx?

(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.

What is the OptumRx controversy?

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 submit OptumRx prior authorization form?

For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028.

How to submit a claim to OptumRx?

Send completed form with pharmacy receipt(s) to: Optum Rx Claims Department, PO Box 650334, Dallas, TX 75265-0334 Note: Cash and credit card receipts are not proof of purchase. Incomplete forms may be returned and delay reimbursement. Reimbursement is not guaranteed.

How do I submit a prescription?

The United States alleged that these combination prescriptions, which OptumRx filled primarily from a mail order pharmacy location in Carlsbad, California, raised red flags indicating that the prescriptions may not have been intended for legitimate medical use and could lead to abuse or diversion of highly addictive

How do I order OptumRx refills?

Get started or order your refills today Call 1-800-562-6223, TTY 711. Optum Rx is a pharmacy care services company helping clients and more than 59 million members achieve better health outcomes and lower overall costs through innovative prescription drug benefits services.

Optumrx form 2025

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