Hawaii 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) Forms

TMS Authorization Request Form (NEW) - electronic submission

Hawaii DSNP and Medicaid Authorization Request Form

HI Behavioral Health Prior Auth Request Form for Hawaii DSNP and Medicaid
Auth Page for IOP or Residential for Hawaii DSNP and Medicaid