Prior Authorizations and Notifications
Plans administered by Optum Behavioral Health require authorization or notification for specialty outpatient services and most inpatient services.
Begin by selecting the plan type below.
Check your national Gold Card prior authorization status starting Sept. 1
UnitedHealthcare’s annual National Gold Card Program waives prior authorizations on eligible behavioral health procedure codes. Providers with newly earned exemptions will instead be required to complete a short Advance Notification for services effective Oct. 1. Check your status beginning Sept. 1.
The Gold Card program simplifies administrative workflows and reduces overall clinical prior authorization requests. It applies to behavioral health services covered by eligible UnitedHealthcare commercial, Individual Exchange,* Medicare Advantage and UnitedHealthcare Community plans.
Optum Behavioral Health will manage the waiver reviews and notifications for all eligible, network behavioral health services/substance use disorder providers.
Prior Authorization Archive
Additional Resources
Online submission instructions
Submitting requests through the secure portal is the first step toward a timely decision on the request.
State-Specific Forms
If you are faxing or mailing a request to Optum, some states require you to complete specific forms.
Clinical Criteria
Optum uses evidence-based clinical criteria from a variety of resources to help make coverage determinations.
Patient and Provider Resources
Access toolkits, assessments, select medication information and more to help you provide care to members.
Applied Behavior Analysis requirements
Authorization of ABA treatment is a 2-step process for most health plans. It begins with a comprehensive assessment to confirm the autism spectrum disorder diagnosis. Then, you must request prior authorization and submit supporting clinical documentation before providing services.
Check benefits before each visit
The Provider Express secure portal makes it easy to review a member’s benefit plan and verify what services require authorization or notification. You can also use the secure portal to quickly submit authorization requests and check the status of requests in process.
Please note the included Medicare Prior Authorization list can be used to confirm DSNP Medicare services prior authorization requirements only. The Medicare Prior Authorization list is not inclusive of the Medicaid services and prior authorization requirements for DSNP members. To confirm the Medicaid services prior authorization requirements, please be sure to also check the coordinating state and product specific Medicaid Prior Authorization list.
For all of the states listed below, Optum does not manage the Medicaid benefits. Therefore, the Medicaid prior authorization requirements will have to be confirmed with the appropriate Medicaid Managed Care Organization.
- Delaware, Georgia, Iowa, Oklahoma, and Pennsylvania