Washington Authorization Forms
Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. Optum administers a wide range of benefits.
Click here to confirm member specific eligibility and benefits: this requires log-in (located in upper right corner)
If you do not have an account, you can create one by clicking on First-Time user.
Click here to determine when a prior authorization request is required, as well as any pre-service requirements or required documentation.
Click here to review Clinical Review Criteria used to evaluate prior authorization requests.
Below are the available forms that can be used
ABA Assessment & Treatment Plan Forms
- ABA Assessment Requests - electronic submission (commercial ABA providers only)
- ABA Treatment Plan - electronic submissions
Psychological Testing Request Forms
- Optum Psych Testing Request Form - electronic submission
- Medica Psych Testing Request Form
Transcranial Magnetic Stimulation (TMS) & Electroconvulsive Therapy (ECT) Forms
- TMS & ECT Authorization Request Forms (NEW) - electronic submission
Washington Medicaid IMC Authorization Form
Washington Electronic Submission Form - commercial providers only
- Washington Prior Authorization - electronic submission