Optum Rx Form Downloads. Claim form – Commercial (pdf) Claim form – Medicare Part D (pdf) Step Therapy Exemption Form (pdf) Prior Authorization Request Form including Fax Number …

Use this form to order a new mail service prescription by fax from the prescribing physician’s office.

Find forms for claim reimbursement, Medicare and Medicaid, prior authorization requests and privacy and confidentiality.

Request refills, track order status, manage billing information and much more. Download and fill out this form form to ask to send your records to another location. Please use this form to ask …

Optum Rx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations. Visit go.covermymeds.com/OptumRx to …

Access office-based forms for ordering specialty medications at OptumRx.

Find directories, forms and training materials in your state by using the filters to narrow your search.

If you are filing for reimbursement on behalf of a patient, please have at least one of the following documents ready to upload to verify your representation, or use the forms provided below:

Forms. Forms. Optum Rx Downloads. Paper claim reimbursement form (pdf) Client Documents. Premium Value Formulary (pdf) Premium Formulary (pdf) HDHP Preventative Drug List (pdf) …

Use this form to request reimbursement for covered medications purchased at retail cost. Complete one form per member. Please print clearly. Additional information and instructions …