Optum Provider Appeal Form - Optum rx prior authorization department p.o. Box 25183 santa ana, ca 92799. Visit the resources section at the following website: Use this form to challenge, appeal or request reconsideration of a claim. Your questions can be answered via live chat. Log into secure transactions and the appeals option is prominent in the main navigation bar. Web download the form below and mail or fax it to unitedhealthcare: Complete this step if you disagree with the outcome of a prior authorization request or a processed claim decision. Complete a reconsideration request form (available on providerexpress.com > admin resources > forms). Web optumcare network of connecticut provider dispute resolution form subject:
Your questions can be answered via live chat. Web optumcare network of connecticut provider dispute resolution form subject: Log into secure transactions and the appeals option is prominent in the main navigation bar. Complete a reconsideration request form (available on providerexpress.com > admin resources > forms). Complete this step if you disagree with the outcome of a prior authorization request or a processed claim decision. Use this form to challenge, appeal or request reconsideration of a claim. Optum rx prior authorization department p.o. Web download the form below and mail or fax it to unitedhealthcare: Box 25183 santa ana, ca 92799. Visit the resources section at the following website: