Massachusetts 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

Emergency Admission Notification Online Form

Emergency Admission Notification Online Form

Psychological Testing Request Forms

Optum Psych Testing Request Form - electronic submission

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

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

Uniform Treatment Plans (UTP)

Massachusetts Level of Care Request

Online (instructions below), Fax: 844-330-4967, Email: utp-phlp@optum.com

Massachusetts Psychological and Neuropsychological Assessment Supplemental Form

Online (instructions below), Fax: 888-960-8129

Massachusetts Repetitive Transcranial Magnetic Stimulation (TMS) Request

Online (instructions below), Fax: 844-330-4967, Email: utp-phlp@optum.com