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
- ABA Assessment Requests - electronic submission (commercial ABA providers only)
- ABA Treatment Plan - electronic submissions
- To download, click DMAS VA MHS Forms
Behavioral Health UM Authorization Request Form (Commercial, Medicare)
Psychological Testing Request Forms
- Optum Psych Testing Request Form - electronic submission
Mental Health Services Online Prior Authorization Training
Mental Health Authorization Request: Log in to proceed to Auth Request
Facility-based Mental Health Services
Transcranial Magnetic Stimulation (TMS)
- TMS Prior Authorization Request Process Training
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.