Skip To Content

Change Healthcare Cyber Response

Change Healthcare is experiencing a cyber security issue. Learn more about the UnitedHealth Group response to the issue, including information on the Temporary Funding Assistance Program and options to submit claims. Learn More

-

Massachusetts Authorization Forms

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:

ABA Assessment & Treatment Plan Forms

ABA Assessment Requests - electronic submission (commercial ABA providers only)
ABA Assessment/Treatment Requests - printable PDF
ABA Treatment Plan - electronic submissions

Emergency Admission Notification Online Form

ED Boarding Notification and Concurrent Updates

Psychological Testing Request Forms

Optum Psych Testing Request Form - electronic submission

Transcranial Magnetic Stimulation (TMS)

TMS Prior Authorization Request Process Training

Uniform Treatment Plans (UTP) (For Commercial Plan use only)

Massachusetts Level of Care Request

Online (instructions below), Fax: 844-330-4967, Email: utp-phlp@optum.com

Massachusetts Psychological and Neuropsychological Assessment Supplemental Form

Online (instructions below), Fax: 888-960-8129

Massachusetts Repetitive Transcranial Magnetic Stimulation (TMS) Request

Online (instructions below), Fax: 844-330-4967, Email: utp-phlp@optum.com

Massachusetts UTP Online Submission Instructions