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Advance Directive
Advance Directive Form
Advanced Imaging Authorization Forms
CT/CTA Authorization Form
MRI/MRA Authorization Form
PET/Spectroscopy Authorization Form (2009)
Sentara Medical Solutions Form
Billing Services
Billing Services Form Instructions
Billing Services Form
Diabetes
Diabetes Supply Order Form
DME
DME Authorization Form
Drug Authorization Forms
(Need an authorization for an Optima Medicare member? Visit Medicare Drug Authorization Forms.)
17-P Authorization
Abilify Authorization
Aceon Authorization
Achthar Gel Authorization
Aciphex Authorization
Actiq Authorization
Adipex-P Authorization
Adderall XR Authorization
Ambien CR Authorization
Amerge Authorization
Amevive Authorization
Aranesp Authorization
Atacand/Atacand HCT Authorization
Avalide Authorization
Avapro Authorization
Avastin Authorization
Avonex Authorization
Axert Authorization
Azor Authorization
Banzel Authorization
Benicar/Benicar HCT Authorization
Betaseron Authorization
Boniva IV Authorization
Botox Authorization
Caduet Authorization
Celebrex Authorization
Cimzia Authorization
Cozaar Authorization
Crestor Authorization
Cymbalta Authorization
Daytrana Authorization
Differin Authorization
Diovan/Diovan HCT Authorization
Edluar Authorization
Effexor XR Authorization
Enbrel Authorization
Epogen Authorization
Euflexxa Authorization
Exforge Authorization
Fentora Authorization
FluMist Authorization
Focalin XR Authorization
Frova Authorization
Geodon Authorization
Growth Hormone Authorization
Hyalgan Authorization
Hyzaar Authorization
Humira Authorization
Imitrex Authorization (for brand)
Implanon Authorization
Invega Authorization
Ionamin Authorization
IVIG Authorization
Kepivance Authorization
Kapidex Authorization
Keppra XR Authorization
Kineret Authorization
Lescol, XL Authorization
Leukine Authorization
Lexapro Authorization
Lipitor Authorization
Lovaza Authorization
Lunesta Authorization
Luvox CR
Lyrica Authorization
Maxalt Authorization
Maxalt-MLT Authorization
Medical Necessity Request Form
Meridia Authorization
Metadate CD Authorization
Micardis/Micardis HCT Authorization
Neulasta Authorization
Neumega Authorization
Neupogen Authorization
Nexavar Authorization
Nexium Authorization
Norfolk Consortium For Smoking Cessation
Nucynta Authorization
Nuvigil Authorization
Onglyza Authorization
Opana ER Authorization
Opana Authorization
Orencia Authorization
Orthovisc Authorization
Oxycontin Authorization
Paxil CR Authorization
Pharmacy Pre-Authorization
PharmaCare Request Form for Injectables (2009)
Prevacid Authorization
Prialt Authorization
Pristiq Authorization
Procrit Authorization
Protonix Authorization
Provigil Authorization
Reclast Authorization
Relistor Authorization
Remicade Authorization
Retin-A Authorization
Revatio Authorization
Revlimid Authorization
RhoD Authorization
Risperdal PO Authorization
Risperdal Consta Authorization
Ritalin LA Authorization
Rituxan Authorization
Rozerem Authorization
Samsca Authorization
Sandostatin Authorization
Savella Authorization
Seroquel Authorization
Serostim Authorization
Simcor Authorization
Singulair Authorization
Sonata Authorization
Stadol Nasal Spray Authorization
Strattera Authorization
Supartz Authorization
Sutent Authorization
Symlin Authorization
Synagis Authorization (2009)
Synarel Authorization
Synvisc Authorization
Synvisc-One Authorization
Tekturna/Tekturna HCT Authorization
Teveten/Teveten HCT Authorization
Tykerb Authorization
Thyrogen Authorization
Torisel Authorization
Treximet Authorization
Trilipix Authorization
Tysabri Authorization
Ulesfia Authorization
Vectibix Authorization
Vimpat Authorization
Vivaglobin Authorization
Vytorin Authorization
Vyvanse Authorization
Xenical Authorization
Xolair Authorization
Xopenex Authorization
Zegerid Authorization
Zomig Authorization
Drug Lists
Preferred and Standard Drug List
2010 Optima Medicare (PPO) Drug List
2009 Optima Medicare (PPO) Drug List
Optima Medicare (PPO) Appeal and Grievance Process
Prior Authorization, Step-Edit and Quantity Limits Drug List
Generics Plus Formulary
Optima Health Injectable & Infusion Medication List
Electronic Funds/Remittance Transfers
EDI Transaction Overview
EDI Setup form - Providers
GYN Authorization
GYN Procedure Request Form
Lab
In-Office Lab List
Medical Record Documentation Standards
Medical Record Documentation Standards
NPI Submission
NPI Information
NPI Online Submission
NPI Submission Form
OB Forms
OB Certification Form
Oxygen
Medical Necessity Ordering Form for Oxygen
Pediatric
Pediatric Health Maintenance Guidelines
Recommendations for Preventive Pediatric Health Care (EPSDT)
Pharmacy Order Forms
PharmaCare Request Form for Injectables
Caremark Mail Service Form
Mirena Eligibility Form
Mirena Order Form
Pre-Existing Condition
Pre-Existing Condition Form
Private Duty Nursing Request Forms
Private Duty Nursing Request Form (COVA Connect Only)
Private Duty Nursing Request Form (Optima Family Care Only)
Provider Connection Forms
Minimum system requirements
Provider Connection Optima Health Enrollment Form
Reconsiderations
Provider Reconsideration Form
Referral and Authorization Request
Referral and Authorization Request Form
Authorization Request Form
Medicare Part D Coverage Determination Request Form
Release of Information
Release of Information Form
Site Evaluation
PCP/OB/Gyn Practice Site Evaluation Form
Therapy
Authorization for Therapy Worksheet
Transitional Care Request Form
Transitional Care Request Form
Well Child Forms
Well Child and Adolescent Well Child Forms
EPSDT Coding Reference Sheet (New)