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Arizona Authorization Forms

Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. Optum administers a wide range of benefits. 

Click here to confirm member specific eligibility and benefits: this requires log-in (located in upper right corner)
If you do not have an account, you can create one by clicking on First-Time user. 

Click here to determine when a prior authorization request is required, as well as any pre-service requirements or required documentation. 

Click here to review Clinical Review Criteria used to evaluate prior authorization requests. 

Arizona Prior Authorization Request Process

Below are the available forms that can be used: 

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) & Electroconvulsive Therapy (ECT) Forms

All other Non-Routine Services - Arizona Electronic Submission Form - commercial providers only