Member forms
On this page you’ll find important forms you can use to request coverage exceptions, request prior authorization, and more.
Administrative Forms
Prior Authorization Form MI
Download:
Authorization to Release PHI MI
Download:
Appeals and Grievances
Coverage Determination Form (OptumRx) MI
Download:
Redetermination Request Form MI
Download:
Coverage Determination Forms MI
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File a Complaint MI
Appointment of Representative Form
Appointment of Representative Form
Download: