Hawaii 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)

• TMS Prior Authorization Request Process Training
  • Provider Express - Login Training
  • Prior Authorization Request
  • Please Login and proceed to Auth Inquiry

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