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:
Louisiana 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
- Medica Psych Testing Request Form
Transcranial Magnetic Stimulation (TMS) & Electroconvulsive Therapy (ECT) Forms
- TMS & ECT Authorization Request Form (NEW) - electronic submission
Authorization Templates
- Assertive Community Treatment (ACT) Template
- Crisis Intervention Template
- Electroconvulsive Therapy (ECT) Template
- Healthy Louisiana Mental Health Rehabilitation and Evidence Based Practices Request Form - electronic submission
- Substance Abuse Intensive Outpatient Program (SA IOP) Template
- Therapeutic Group Home (TGH) Template