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What does prior authorization mean for prescriptions?

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you dont get prior authorization, a medication may cost you more, or we may not cover it.

How long does OptumRx take for prior authorization?

Learn more at optum.com. How long does it take for a prior authorization to be approved or denied? Once your PA has been submitted and received, it usually takes up to 24 hours to process. If your PA request needs additional review, it may take longer.

How do I fax a prescription to OptumRx?

Fax 1-800-491-7997 Send a complete prescription using the Physician Fax Form.

What is the pa fax number for OptumRx?

Fax this form to: 1-866-434-5523 Phone: 1-866-434-5524 OptumRx will provide a response within 24 hours upon receipt.

What is the fax number for OptumRx appeals and grievances?

Have your provider fax OptumRx at 844-403-1028.

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What is a prior authorization and why do you need it?

Prior authorizationsometimes called precertification or prior approvalis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

What is OptumRx prior authorization?

Prior authorization (PA) requires your doctor to tell us why you are taking a medication to determine if it will be covered under your pharmacy benefit. Some medications must be reviewed because they may: Only be approved or effective for safely treating specific conditions.

What insurance companies use OptumRx?

Who is OptumRx? OptumRx is your CalPERS pharmacy benefit manager for Anthem, Health Net, Sharp, UnitedHealthcare, and Western Health Advantage. Our goal is to provide safe, easy and cost-effective ways for you to get the medication you need.

Where do I send my payment for OptumRx?

Mailing address for order forms OptumRx. PO Box 2975. Mission, KS 66201.

What is the PA department number for 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.)

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