Kansas Authorization Forms

Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. Optum administers a wide range of benefits. Select your state to locate the appropriate authorization forms.

ABA Assessment & Treatment Plan Forms

• ABA Assessment Requests - electronic submission (commercial ABA providers only)
• ABA Treatment Plan - electronic submissions

KanCare Medicaid Authorization Forms

• KanCare Inpatient Prior Auth Form
• KanCare PRTF Prior Auth Form

Psychological Testing Request Forms

• Optum Psych Testing Request Form - electronic submission
• KanCare Psych Testing Request Form

Transcranial Magnetic Stimulation (TMS) & Electroconvulsive Therapy (ECT) Forms

• TMS & ECT Authorization Request Form (NEW) - electronic submission