To submit a request for access to the OptumHealth Provider website, you must complete all fields in the form
below. Upon approval of your request, we will forward your userid and password to you.
All fields below that are bolded and marked with an asterisk (*) are required fields.
Desired User ID*
(minimum of 7 characters)
(minimum of 7 characters,
(e.g. RN, MD, CCM)
(role in your organization)
Alabama (AL)Alaska (AK)Arizona (AZ)Arkansas (AR)California (CA)Colorado (CO)Connecticut (CT)Delaware (DE)District of Columbia (DC)Florida (FL)Georgia (GA)Hawaii (HI)Idaho (ID)Illinois (IL)Indiana (IN)Iowa (IA)Kansas (KS)Kentucky (KY)Louisiana (LA)Maine (ME)Maryland (MD)Massachusetts (MA)Michigan (MI)Minnesota (MN)Mississippi (MS)Missouri (MO)Montana (MT)Nebraska (NE)Nevada (NV)New Hampshire (NH)New Jersey (NJ)New Mexico (NM)New York (NY)North Carolina (NC)North Dakota (ND)Ohio (OH)Oklahoma (OK)Oregon (OR)Pennsylvania (PA)Puerto Rico (PR)Rhode Island (RI)South Carolina (SC)South Dakota (SD)Tennessee (TN)Texas (TX)Utah (UT)Vermont (VT)Virgin Islands (VI)Virginia (VA)Washington (WA)West Virginia (WV)Wisconsin (WI)Wyoming (WY)
The following role applies to my interaction with OptumHealth Care Solutions - Complex Medical Conditions*:
Access Request Reason / Notes:
You will have to agree to the Disclaimer prior to using your login.
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