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:
Texas Authorization Forms
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
Transcranial Magnetic Stimulation (TMS) Forms
- TMS Authorization Request Form (NEW) - electronic submission
Uniform Treatment Plan (UTP)
Fax completed UTP forms to 1-877-235-9905, unless requesting TX SB 58 Services. If requesting TX SB 58 Services, fax completed TX UTP to 1-877-450-6011.
Texas Medicaid Prior Authorization
- Optum Texas Medicaid Prior Authorization Form Fax number: 844-280-1168
- TDI Texas Medicaid Prior Authorization Form Fax number: 844-280-1168