Arizona 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:

In Network Facility requesting authorization for Inpatient, Residential or Partial Hospitalization form

ABA Assessment & Treatment Plan Forms

Psychological Testing Request Forms

Transcranial Magnetic Stimulation (TMS) Forms

Providers serving Arizona Medicaid and some commercial members may request other services and levels of care not listed here, by selecting this Arizona form to initiate an Auth Request or call the number on the back of the member's ID card