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 1. Optum Workers' Comp and Auto No-Fault
 2. Referrals

-


REFERRAL FORMS

HELPING A CLAIMANT FIND SERVICES? TURN TO US FOR ANCILLARY SUPPLIES, SETTLEMENT
FUND MANAGEMENT, OR PHARMACY BENEFITS.

 


ANCILLARY REFERRAL FORMS



To use our interactive referral form:

 1. Download the file, do not use a web browser to fill out the form.
 2. Complete all the required fields, if one is missed you will be prompted to
    fill out that field.
 3. Click the "Submit by email" button and include any additional documentation.



Optum Workers' Comp Ancillary Referral form



Optum Auto No-Fault Ancillary Referral form





If you are unable to utilize the interactive features of the form, please
download, save this file, and send as an attachment and include any additional
documentation in support of the request, such as prescriptions, doctors orders,
evaluations, etc,. to: OptumWC.Ancillary@optum.com

or save this file and fax the completed form and attachments to 1-800-774-4111

If you need further assistance, please call us at 1-833-486-7886, option 2.




AUTO NO-FAULT PHARMACY REFERRAL FORM

 * Auto Pharmacy Referral Form


SETTLEMENT SOLUTIONS

 * Liability Referral Opens in a new window
 * Workers' Compensation Referral Opens in a new window





If you have a question or need support,
visit our Contact us page



Follow us





Workers' Compensation

 * Pharmacy Care Services
 * Ancillary Services
 * Managed Care Services
 * Settlement Solutions

Auto No-Fault

 * Pharmacy Care Services
 * Ancillary Services
 * Auto Managed Care Services
 * Settlement Solutions

Resources


 * Continuing Education
 * Webinars on demand
 * Tmesys Network Opens in a new window
 * Ask-a-pharmacist



Resources for


 * Workers’ comp professionals
 * Workers' comp providers
 * Injured workers


 * Auto no-fault professionals
 * Auto no-fault providers
 * Auto no-fault claimants

Insights


 * Thought Leadership
 * Blogs
 * Podcasts
 * Articles

Contact




About


 * Leadership



Pharmacy locator


 * Digital pharmacy card



Workers' Compensation and Property and Casualty Pharmacy Benefit Management
09/01/2025




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 * Accessibility Statement

The following entities comprise the Optum Workers’ Compensation and Auto
No-Fault division: PMSI, LLC, dba Optum Workers’ Compensation Services of
Florida; Progressive Medical, LLC, dba Optum Workers’ Compensation Services of
Ohio; Cypress Care, Inc. dba Optum Workers’ Compensation Services of Georgia;
Healthcare Solutions, Inc., dba Optum Healthcare Solutions of Georgia; PMSI
Settlement Solutions, LLC, dba Optum Settlement Solutions; Procura Management,
Inc., dba Optum Managed Care Services; Equian, LLC, collectively and
individually referred as “Optum.” Optum and its respective marks are trademarks
of Optum, Inc. All other brands or product names are trademarks or registered
marks of their respective owners. Because we are continuously improving our
products and services, Optum reserves the right to change specifications without
prior notice. Optum is an equal opportunity employer.



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