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Catalyst rx prior authorization form 2025

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The document is a prior authorization form for medical necessity, requiring detailed member and drug information to be completed and faxed to Catalyst Rx. It outlines the need for alternative therapies attempted, relevant medical data, and physician details. The form emphasizes the discretion of the benefit manager in overriding coverage restrictions.

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Click ‘Get Form’ to open the catalyst rx prior authorization form in the editor.
Begin by filling out the MEMBER INFORMATION section. Enter the member's first name, last name, plan, member ID, and date of birth accurately.
Next, move to the DRUG INFORMATION section. Input the drug name, quantity, ICD-9 code, directions for use, and duration of therapy.
Provide a detailed diagnosis and list any alternative therapies that have been attempted along with pertinent information related to the drug or disease state.
Complete the PHYSICIAN INFORMATION section by entering the physician's signature, date, name, NPI number, phone number, and fax number.
Indicate if action is needed by marking 'Urgent' only if necessary. Finally, review all entries for accuracy before submitting.

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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.

catalyst rx prior authorization form

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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.

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.