covered medication, and/or OptumRx will offer information on the process to appeal the adverse decision. Please complete all pages to avoid a delay in our decision. If you are new to electronic prior authorizations (ePA), here are a few benefits to consider: Saves time: Providers who report using ePA submissions on average spend 2.5 fewer hours on PAs per week*, Provides real-time submissions with typical resolutions in less than 5 minutes at no additional cost, Eliminates wait time on the phone or using manual fax forms, Reduces disruptions to patient care, Allows renewals to be created from previous submissions, Includes specific clinical questions pertinent to patient plan requirements, Reduces paperwork: Process is eco-friendly, Protects patient health information: Provides secure transmission using the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard, Save time today and submit your PA requests to OptumRx through any of the following online portals:**. hbbd```b``:"@$"&&@${ "Y`. 14 0 obj OptumRx Prior Authorization Guidelines and Procedures telephone or fax. Enter your official identification and contact details. hb```g``fa`e`X}A@,3.Y600Ix^ ` DPL-Footer Legal And Social Bar Component, Utilization management changes, effective 01/01/23, Fraud, waste, abuse and general compliance, Language Assistance / Non-Discrimination Notice, Asistencia de Idiomas / Aviso de no Discriminacin. Select the area you want to sign and click. Crohn's/Ulcerative Colitis. After that, your optimal prior authorization form is ready. Allow at least 24 hours for review. Certain states require Optum Rx to communicate prior authorization changes before the effective date. endobj 414 0 obj <>stream We offer other various resources to help support your understanding and use of ePA. PDF Prior Authorization Request Form - UHCprovider.com If you are new to electronic prior authorizations (ePA), here are a few benefits to consider: Saves time: Providers who report using ePA submissions on average spend 2.5 fewer hours on PAs per week*, Provides real-time submissions with typical resolutions in less than 5 minutes at no additional cost, Eliminates wait time on the phone or using manual fax forms, Reduces disruptions to patient care, Allows renewals to be created from previous submissions, Includes specific clinical questions pertinent to patient plan requirements, Reduces paperwork: Process is eco-friendly, Protects patient health information: Provides secure transmission using the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard, Save time today and submit your PA requests to OptumRx through any of the following online portals:**. Press Done after you finish the blank. . stream Submitting an electronic prior authorization (ePA) request to OptumRx 141 0 obj Optumrx Prior Authorization Appeal Form 2019-2023 Use a go covermymeds optumrx 2019 template to make your document workflow more streamlined. Refer to the Support section or contact our Support crew in the event that you have any concerns.
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