844-403-1027 (2024)

1. [PDF] Prior Authorization Request Form - UHCprovider.com

  • This form may be used for non-urgent requests and faxed to 1-844-403-1027. OptumRx has partnered with CoverMyMeds to receive prior authorization requests ...

2. Individual Exchange plans Prior Authorization and Exceptions

  • By faxing a request form to 844-403-1027. State-specific request forms are at Individual Exchange Plan Information for Providers. The request should include ...

  • Some medications require prior authorization or may need an exception.

3. [PDF] Fax: Phone: Re: Optum Rx Prior Authorization Department 1-844 ...

  • This document and others if attached contain information that is proprietary, confidential and/or may contain protected healt h information (PHI). We are.

4. [PDF] Texas Standard Prior Authorization Request Form for Prescription Drug ...

5. [PDF] Healthcare Reform Copay Waiver Request Form - Optum

  • This form may be used for non-urgent requests and faxed to 1-844-403-1027. Healthcare Reform Copay Waiver Request Form. DO NOT COPY FOR FUTURE USE. FORMS ARE ...

6. [PDF] Prior Authorization Request Form Member Information(required ...

  • This form may be used for non-urgent requests and faxed to 1-844-403-1027. Optum Rx has partnered with CoverMyMeds to receive prior authorization requests ...

7. [PDF] The fax number for the OptumRx Prior-Authorization Request Form ...

  • The fax number for the OptumRx Prior-Authorization. Request Form on the next page has changed. The new fax number is: 1-844-403-1027. Page 2 ...

8. [PDF] UNIFORM PHARMACY PRIOR AUTHORIZATION Request Form

9. [PDF] Request for Medicare Prescriptive Drug Coverage Determination

  • Missing: 844-403-1027 | Show results with:844-403-1027

10. [PDF] 2023 Medicare Advantage PPO plans in Michigan

  • • Fax 844-403-1027. Injectable drug prior authorization requests. • Call 800-711-4555, option 2. Prescription coverage/pricing: UHCprovider.com ...

11. Payer Resource

  • Please submit the Prior Authorization directly to the Pharmacy Benefit Manager OptumRx by FAX 844-403-1027 or through Cover My Meds. Upon approval, please ...

12. [PDF] OptumRx Prior Authorization Form.pdf

  • This document and others if attached contain information that is privileged, confidential and/or may contain protected health information (PHI).

13. Providers and Pharmacists - CarelonRx

  • We value your time. This page is designed to direct you to the tools and resources that you may need. Are you a pharmacist having issues processing a pharmacy ...

  • At CarelonRx, we value our relationships with providers and pharmacists. We designed tools and resources that help you serve your patients. Learn more.

14. Prior Authorization Fax Information - CVS Caremark

  • Prior Authorization Information. CVS Caremark Prior Authorization (PA) tools are developed to ensure safe, effective and appropriate use of selected drugs.

  • Skip to main content

15. [PDF] Medi-Cal Rx Prior Authorization Request Form

  • Instructions: Fill out all applicable sections on all pages completely and legibly. Attach any additional documentation that is important for the review ...

844-403-1027 (2024)

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