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Forms and resources for health care professionals (146)

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    Advance beneficiary notice of noncoverage (ABN)

    Please complete and return the form to the requesting department.

    Advance beneficiary notice of noncoverage (ABN)

    Please complete and return the form to the requesting department.

    Alpha-1 referral form

    Optum Infusion Pharmacy referral/enrollment form for alpha-1 proteinase inhibitor therapy

    Appeal information request policy

    This policy outlines the process for sending denial documents to the health plan or QIO for appeal consideration.

    Authorization to use and disclose protected health information

    Please complete and return the form to the requesting department.

    Benzodiazpines Prior Authorization Form

    This is a Medicare form for benzodiazepines prior authorization requests.

    Biologics infusion referral form

    Complete and return this form to refer a patient for biologic infusion therapy with Optum Infusion Pharmacy.

    Cancer Guidance Program Contract Termination

    Provider notification of change in how authorization is obtained for chemo therapy drugs

    Care transition procedures

    This document defines the process for discharging and safely transitioning Medicare Advantage patients from an inpatient facility.

    Claims provider manual

    Our provider claims guide offers our network providers key information and support in submitting claims.

    Colorado Prior Authorization Form

    This form for Optum Rx (non-Medicare) and UnitedHealthcare (non-Medicare).

    Complex case management (CCM) process

    This document outlines the steps involved in identifying, educating and helping these patients.

    Connecticut Prior Authorization Alert (OCN)

    Reference for obtaining Prior Authorization lists and guidelines.

    Delaware Prior Authorization Form

    The form is for UnitedHealthcare (non-Medicare).

    Dermatology referral form

    Optum specialty referral form for Dermatology. Send us the form and we will take care of the rest.

    Diabetes management (DM) process

    This document describes the process for providing diabetes disease management program services to members.

    Direct admit to SNF form

    Complete this form to initiate an admission to a skilled nursing facility (SNF).

    EDI Companion Guide

    HIPAA Companion Guides describe Optum Rx specific technical details for EDI transactions.

    Evidence in action

    Get a closer look at how evidence is advancing life sciences.

    Fertility general referral form

    Optum specialty fertility referral form. Send us the form and we will take care of the rest.

    Florida Prior Authorization Form

    This form for Optum Rx (non-Medicare) and UnitedHealthcare (non-Medicare).

    Gastroenterology referral form

    Optum specialty referral form. Send us the form and we will take care of the rest.

    General referral form

    General Optum specialty referral form. Send us the form and we will take care of the rest.

    Healthcare Reform Copay Waiver Request Form

    This for is for UnitedHealthcare (non-Medicare).