Nebraska Authorization Forms

Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. Optum administers a wide range of benefits. Select your state to locate the appropriate authorization forms.

ABA Assessment & Treatment Plan Forms

• ABA Assessment Requests - electronic submission (commercial ABA providers only)
• ABA Treatment Plan - electronic submissions
• NE Medicaid ABA Treatment Request Form

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

Nebraska Medicaid Authorization Forms

• Nebraska Certification of Need for Services
  
• Nebraska Crisis Stabilization Admission Notification
• Nebraska LAI Buy and Bill Authorization Request
• Nebraska Medicaid ABA Treatment Request Form
  
• Nebraska Medicaid Critical Incident Report
• Nebraska MRO Authorization Request
• Nebraska Community Mental Health Services Request Form