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Virginia Authorization Forms

The process for requesting some Virginia Mental Health services has changed. 

Using the enhanced optimized experience in the Provider Express secure portal, you can now:

  • View real-time status updates
  • Search by member
  • Track requests, outcomes, and view authorization details

Log in to the Provider Express secure portal use the new process. 

Plans administered by Optum behavioral do not require prior authorization for routine outpatient services. For Virginia CCC Plus or Medallion 4.0, see specific section below. If you need authorization for any of the following services, please select the link below:

ABA Assessment & Treatment Plan Forms

Behavioral Health UM Authorization Request Form (Commercial, Medicare)

Psychological Testing Request Forms

Mental Health Services Online Prior Authorization Training

  • Stay tuned for this training addition!

Mental Health Authorization Request: Log in to proceed to authorization inquiry

Transcranial Magnetic Stimulation (TMS)

Virginia CCC Plus or Medallion 4.0 ARTS Service Registration and Authorization Forms

To ensure timely processing, please make sure your request meets all of the following criteria:

> You are using a current DMAS form for the specified service

> The member is a current eligible member of the CCC Plus or Medallion 4.0 Plans

> The services being requested are for ARTS

> There is only one member/one service per fax

> All information is complete and legible

You will be mailed a confirmation letter with an authorization number.

To download, click DMAS ARTS Forms

All ARTS forms can be faxed to (855) 368-1542, or follow specific online submission instructions. For questions, call (877) 843-4366.