O4 Hubs

Forms and resources for health care professionals

Immunoglobulin referral form

Optum Infusion Pharmacy IVIG and SCIG referral/enrollment form. Send us the referral and we will take care of the rest.

Unbranded IV anti-infectives referral form

Unbranded antibiotic infusion referral/enrollment form

Hemophilia and bleeding disorders referral form

Optum Infusion Pharmacy referral/enrollment form for hemophilia and bleeding disorders. Send us the referral and we will take care of the rest.

IV anti-infectives referral form

Optum Infusion Pharmacy referral/enrollment form for antibiotics. Send us the referral and we will take care of the rest.

Home parenteral nutrition referral form

Optum Infusion Pharmacy referral/enrollment form for parenteral nutrition. Send us the referral and we will take care of the rest.

Multiple sclerosis referral form

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

Oncology referral form

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

Immune globulin therapy enrollment form

Optum specialty referral/enrollment form for immune globulin. Send us the form and we will take care of the rest.

Growth hormone referral form

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

Makena referral form

Optum specialty fertility referral form for Makena (17P).

Jynarque® enrollment form

Please complete and return the form to the requesting department.

Neuromuscular disorder referral form – migraine, cervical dystonia, overactive bladder

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

Hepatitis C referral form

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

Crohn's/ulcerative colitis referral form

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

Hepatitis C Proteus program referral form

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

Enzyme replacement therapy referral form

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

Pulmonary arterial hypertension referral form

Optum specialty referral form for pulmonary arterial hypertension (PAH). Send us the form and we will take care of the rest.

Osteoarthritis referral form

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

Oncology REMS referral form

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

Ophthalmology referral form

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

Neuromuscular disorder referral form

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

Neuromuscular refill request form

Optum specialty office-based refill shipment request form

Hematopoietic 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.

Sublocade standard referral form

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

Osteoporosis referral form

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

Cystic fibrosis referral form

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

HIV referral form

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

Synagis referral form

Optum Specialty RSV referral form for Synagis.

Synagis order form

Optum Specialty order referral form for office based Synagis.

Mental health refill referral form

Optum specialty office based refill form for mental health.

Unbranded Ocrevus referral form

Unbranded infusion referral form

Xolair reorder form

Optum specialty office based reorder form for Xolair.

General refill referral form

General Optum specialty refill shipment request.

Injectable psychotropic medication referral form

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

Makena reorder referral form

Optum specialty reorder referral form for Makena.

Transplant referral form

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

Rheumatology referral form

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

Neuromuscular disorder referral form– achalasia, chronic anal fissure, fetrusor overactivity, spasticity, bleopharospasm

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

Unbranded immunoglobulin referral form

Unbranded IVIG and SCIG infusion referral/enrollment form

Ocrevus referral form

Optum Infusion Pharmacy referral/enrollment form. Send us the referral and we will take care of the rest

Healthcare effectiveness data and information

Use this reference guide to learn how we measure performance.

Patient program referral forms

Use these forms when working with patients in Colorado.

Medical coverage decision criteria

See criteria by plan to help determine coverage eligibility.

Forum for evidence-based medicine: COVID-19 issues

Sign up for educational information about COVID-19.

Provider lookup tool

Find doctors in Arizona.

Primary care provider referral forms

View primary care provider referral forms for Colorado.

Contracted provider appeal for medical necessity

Complete this form for a medical necessity appeal.

Optum Care Resources For New Mexico Clinicians

Explore clinician resources.

Medical management quick reference guide

Get important details for the Optum Care medical management programs.

Medical management quick reference guide

Get important details for the Optum Care medical management programs.

Arizona Radiology Directory

Find radiology and imaging locations in Arizona.

Humana Electronic Remittance and Appeal Rights in New York

Learn about contracted provider reconsiderations and more.

Utah COVID-19 Health Plan Provisions

The latest UnitedHealthcare COVID-19 related resources.

Premera Electronic Remittance and Appeal Rights

Find information on contracted provider reconsiderations, the appeals process, the payment dispute process and health plan dispute review.

Humana Electronic Remittance and Appeal Rights

Find information on contracted provider reconsiderations, the appeals process, the payment dispute process and health plan dispute review.

Credentialing Forms in Utah

Get more information about credentialing with Optum.

Utah Oncology Authorization Request Form

Treatment request form for medicine used for chemotherapy.

Affirmative statement

See our utilization management policy in Connecticut.

Vendor partner resources

Find more details about three of our vendor partners; Wound tech, Dispatch Health and Arizona Palliative Home Care.

COVID-19 Provider Email Communication No2

Find details about telehealth, copay, co-insurance and deductible changes.

COVID-19 management in adults

Get a brief overview of COVID-19 in adults.

Utah Supportive Care Referral Form

Get a referral form for patients in Utah.

Laboratory Protocol in Arizona

Use this referral policy for services in Optum Care–Arizona.

Utah SNF Attestation Form

Use this form to show documented evidence of a diagnosis.

Arizona Urgent Care Directory

Find Arizona urgent care locations and contact information.

Nevada COVID-19 Health Plan Provisions

Information and resources on the changing federal and state regulatory health plan requirements related to COVID-19 in Nevada.

COVID-19 and health plan provisions in Connecticut

Get access to the latest plan information and COVID-19 resources.

Urgent care directory

Find urgent care locations and contact information in Utah.

Important update on SNF and LTACH prior authorization

See the updates to prior authorization requirements.

Electronic remittance and appeal rights

Use this form to review provider appeal rights for the Nevada market.

Cultivating community through COVID-19

Learn how we're creating a sense of community and well-being during COVID-19.

UnitedHealthcare MA plan coverage summaries

See coverage summaries and get the latest provider news.

Electronic funds transfer

Learn more about enrolling in EFT and electronic remittance advice (ERA) enrollment.

Prior authorization list

Get a list of codes for the Optum Care–Colorado.

Medical Management Reference Guide

View the Optum Care–Arizona medical management/clinical reference guide.

Clinical Diabetes Management program referral

Learn more about the Optum Clinical Diabetes Management program in Arizona.

Medication Assistance Program

Download the Medication Assistance Program application for your Optum Care patients

Provider quick reference guide

Get important details for the Indiana market.

Provider administrative manual

See our provider guide for the Indiana market.

Evidence in action

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

Provider administrative manual

See our Provider Administration Manual for key information and support in providing effective care for Colorado.

Claims provider quick reference guide

Get important details for provider claims.

Claims provider manual

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

Electronic remittance and appeal rights for Humana

Find information on contracted provider reconsiderations, the appeals process, the payment dispute process and health plan dispute review.

Electronic remittance and appeal rights for Emblem CT

Learn about contracted provider reconsiderations and more.

Electronic remittance and appeal rights for UHC CT

Learn about contracted provider reconsiderations and more.

Curo quick start guide provider authorization module

The Curo provider module quick start guide serves as a high-level overview of the benefits and basic functionality of the platform.

Curo training guide provider authorization module

An in-depth process outline for the Optum provider authorization module.

Optum.com navigation

Learn how to navigate Optum.com; signing in and accessing resources.

Washington provider manual

Our provider manual offers helpful information about Optum Care­–Washington and how to work with us effectively.

Provider change form

Use this form to make changes to practice information.

Washington non-PCP quick reference guide

This guide provides information about prior authorizations and referrals, submitting claims, customer service and more.

Arizona physician and provider update forms

Make NPI, TIN or provider demographic updates.

Medicare Advantage home health prior authorization update

See updated guidelines for home health services.

Referral policy

Learn about changes to our referral policy in Arizona.

Attestation measures guide

Use this guide as a resource to complete quality attestation forms.

Cardiac services directory

View locations for cardiac services in Arizona.

Attestation forms and HCC codes

Find answers about attestation forms and HCC codes.

Biologics infusion referral form

Optum Infusion Pharmacy referral/enrollment form chronic inflammatory disorders such as Crohn's disease, ulcerative colitis, and rheumatoid arthritis. Send us the referral and we will take care of the rest.

Unbranded biologics infusion referral form

Unbranded infusion referral/enrollment form

Arizona Chemotherapy Drug Prior Authorization

Learn more about the prior authorization process.

Optum Care Case Management

Our case management programs help reduce health care spend and keep our most vulnerable members safe.

Important claims submission information

Learn about the preferred method of claims submissions.

Care management referral form

This is a form for fax submissions.

Prior authorization form

View the Optum Care–Colorado prior authorization form.

Prior authorization online submission – tips and tricks

This is a reference for an online submission.

Provider administrative guide

See our provider guide for the Arizona market.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Prior authorization request form

See the prior authorization request form for the Indiana market.

Prior authorization request form

See the prior authorization request form for the Ohio market.

Electronic remittance and appeal rights

Learn about contracted provider reconsiderations and more.

Provider administrative manual

This manual provides detailed provider information for New York.

Provider dispute resolution request

Complete this form to request a dispute resolution.

Provider dispute resolution forms

Use these forms when working with patients in Colorado.

Provider dispute resolution form

Challenge, appeal or request reconsideration of a claim.

Quick reference guide

Get important details for the Connecticut market.

Provider quick reference guide

Get important details for the New Mexico market.

Provider quick reference guide

Get important details for the Washington market.

Provider quick reference guide

Get important details for the New York market.

Provider quick reference guide

Get important information for the Oregon market.

Provider quick reference guide

Get important details for the Ohio market.

CareMount DCE electronic remittance and appeal rights

Learn about contracted provider reconsiderations and more.

Provider administrative manual

See our provider guide for the Ohio market.

Provider quick reference guide

Get important details for the Arizona market in Tucson.

Provider quick reference guide

Get important details for the Arizona market in Maricopa and Pinal County.

Provider quick reference guide

Get important details for seeing patients in Nevada.

Prior authorization request form

View the prior authorization request form for the Kansas and Missouri market.

Diagnosis attestation form quick guide

This attestation form lists the diagnosis/conditions previously reported for a patient or conditions thought to be correct.

Quick reference guide

This document provides helpful information for providers.

Provider administrative guide

This guide identifies the tools and support services available to Optum Care–Kansas City providers.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Electronic remittance and appeal rights

Learn about contracted provider reconsiderations and more.

Prior authorization request form

Use this form to request prior authorization of necessary services. See the prior authorization grid for a list of this year's services.

Comprehensive formulary

Get a list of covered medications for Optum Care in Utah.

Admission notification requirements

Learn more about admitting patients in Arizona.

Compliance prior authorization and claims

Learn more about the correct coding for claims submissions.

COVID-19 provider email communication #1

Use this guide as a resource to complete quality attestation forms.

Cozeva resource guide

If you need help with coding in Cozeva, check out this helpful guide.

COVID-19 member direct mail letter #1

Letter sent to all Optum Care–Arizona members about COVID-19 important updates.

Northern Nevada provider quick reference guide

Get important details for working with Optum Care patients.

Electronic funds transfer (EFT) form

Enroll in EFT for the Connecticut market.

Electronic remittance advice (ERA) form

Find helpful documents to complete your ERA application.

Electronic Remittance & Appeal Rights

Find information on contracted provider reconsiderations, the appeals process, the payment dispute process and health plan dispute review.

Electronic remittance and appeal rights

Learn about contracted provider reconsiderations and more.

Home health guide

Get important details for Home Health Agencies.

Arizona HEDIS quick reference guide

Use the Optum Care–Arizona HEDIS reference guide to learn more about how we measure performance.

Direct admit to SNF form

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

Dermatology referral form

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

Medical management program referral guide and form

Refer a patient for one of our medical management programs.

Washington Provider Manual Medicare

Our provider guide offers our network providers key information and support to provide effective care in the Washington market.

Washington Provider Manual Medicaid

Our provider guide offers our network providers key information and support to provide effective care in the Washington market.

Patient program referral form

Get important details for the Optum Care patient referral programs.

Arizona Nephrology Directory

Use this directory to find facilities in Arizona.

Unbranded parenteral nutrition referral form

Unbranded parenteral nutrition infusion referral/enrollment form

Arizona Lab Directory

Use this form to show documented evidence of a diagnosis.

Fertility general referral form

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

Optum Prepayment Review System quick reference guide

Learn more about the Optum Prepayment Review System.

Optum Care Prior Authorization Form

Prior authorization list alert

Find prior authorization guidelines for 2022.

Prior authorization form

View the Optum Care–New Mexico prior authorization form.

Primary care provider referral form

View the Optum Care–Utah provider referral form.

Patient programs request form

Help your patients connect with support services.

Prior authorization list

Get a list of codes for Optum Care in New Mexico.

Prior authorization grid

View a list of CPT codes requiring a prior authorization.

Prior authorization list

Get a list of codes for Optum Care–Arizona.

Prior authorization grid

View a list of CPT codes requiring a prior authorization.

Prior authorization grid

View a list of CPT codes requiring a prior authorization.

Prior authorization list

Get a list of codes for the Optum Care Network–Utah.

Provider administrative manual

Get key information for the New Mexico market.

Provider Administrative Guide in Utah

See our provider guide for the Utah market.

Provider dispute resolution form

Challenge, appeal or request reconsideration of a claim.

Provider dispute resolution forms

Use these forms for the New Mexico market.

Provider dispute resolution forms

Use these forms for the New York market.

Provider dispute resolution forms

Use these forms for the Indiana market.

Provider dispute resolution forms

Use these forms for the Nevada market.

Provider dispute resolution forms

Use these forms for the Oregon market.

Provider dispute resolution forms

Use these forms for the Ohio market.

Provider quick reference guide

Get important details for the Colorado market.

Provider manual

Get answers to many of your questions about Optum Care–Connecticut.

Provider dispute resolution forms

Use these forms for the Washington market.

Provider manual

See our provider manual for the Nevada market.

Provider dispute resolution forms

Use these forms for the Optum Care Network–Utah.

Provider overview

Learn about the Network of Nevada and accepted plans.

Skilled nursing facilities manual

Get important details for skilled nursing facilitates (SNFs).

Skilled nursing facilities

Use this directory to find preferred SNFs in Arizona.

Information on utilization management

See our affirmative statement about incentives.

Claims FAQ

Get important details about claims in the Utah market.

Step therapy prior authorization requirements

Get prior authorization requirements and instructions.

Specialist referral form

Get a referral form for specialists in Arizona.