To submit a request for access to the Optum Provider website, you must complete all required fields on the form below. Once your request is submitted, you will receive an approval or denial e-mail within 1-2 business days.
If approved, you will receive a second e-mail from firstname.lastname@example.org to create a One Healthcare ID, which you will use to log into the site.
All fields marked with an asterisk (*) are required.
(e.g. RN, MD, CCM)
(role in your organization)
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The following role applies to my interaction with OptumHealth Care Solutions - Complex Medical Conditions*:
Access Request Reason / Notes:
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