Ohio Authorization Forms

In Network Facility requesting authorization for Inpatient, Residential or Partial Hospitalization form

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

Providers (in network or out of network) serving Ohio Medicaid and some commercial members may request other services and levels of care not listed here, by selecting this Ohio form to initiate an Auth Request or call the number on the back of the member's ID card.