Louisiana Authorization Forms
Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. If you need authorization for any of the following services, please select the link below:
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 Form (NEW) - electronic submission
Authorization Templates
- Assertive Community Treatment (ACT) Template
- Crisis Intervention Template
- Electroconvulsive Therapy (ECT) Template
- Healthy Louisiana Mental Health Rehabilitation and Evidence Based Practices Request Form - electronic submission
- Substance Abuse Intensive Outpatient Program (SA IOP) Template
- Therapeutic Group Home (TGH) Template