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.
All Commercial providers for fully insured, sitused members receiving services in the State of Arizona – use this Arizona State mandated electronic request form:
Arizona Electronic Standard Prior Authorization Request Form for Health Care Services
Arizona Standard Prior Authorization Request Form – PDF version
Non-commercial request 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)
TMS Prior Authorization Request Process Training
- Provider Express - Login Training
- Prior Authorization Request
- Please Login and proceed to Auth Inquiry
All other Non-Routine Services - Arizona Electronic Submission Form - commercial providers only
Arizona Electronic Standard Prior Authorization Request Form for Health Care Services
Arizona Standard Prior Authorization Request Form – PDF version