Welcome Kentucky Behavioral Health Providers 

Optum Health Education

Behavioral Health Identification, Treatment and Referral in Primary Care: 3-Part On-Demand Series​

Part 1: Depression and Follow-up After Higher Levels of Care​ Available until June 8, 2027
Part 2: Substance Use Disorders in Primary Care Available until October 31, 2027
Part 3: Behavioral Health Treatment for Children and Adolescents Available until February 14, 2028

            Begin the Training                        Download the Flyer

Provider Relations 

Both on-demand and recurring trainings are available through your Provider Advocate. Please refer to the map to identify the Advocate for your area. 

General Training

Review the Optum Behavioral Health Training webpage for a variety of training options, including how to complete tasks in the Provider Express secure portal, working with EAP referrals and more

Member Eligibility

It is important to verify eligibility and benefits at each visit. The fastest way to verify eligibility and coverage is by logging in to your Provider Express secure portal account.

Behavioral Health Prior Authorizations

• Kentucky Medicaid Prior Authorization List – A comprehensive list of behavioral health services that require authorization
• Kentucky Medicaid Authorization Information – Use this form to gather information that will be needed when you submit an authorization request 

Notifications

Written notification of a prior auth request will be mailed to your address of record with us. For faster status updates, you can log in to the Provider Express secure portal. The portal will display request status, expiration dates and other relevant information.  

Submission Review Timeline

We strive to process prior auth requests in 5 business days. In some instances, case management could contact you for additional information or if a peer review is needed. To check for prior auth status updates, please log in to the Provider Express secure portal.

Member Support

Members can be directed to call member services at 1-866-293-1796.

How to submit requests for authorization

Submit complete and up-to-date documentation to support your authorization requests. 

Use the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal. Need assistance with the submission process?  This self-paced guide can help.

Medical Necessity

Certification of Need – Medicaid Inpatient Psychiatric (Ages 21 and under)

The length and approval of authorizations are often based on medical necessity.

• Standard Clinical Criteria
• Substance Use Disorder Prior Authorization Clinical Criteria

ASAM assessments should be conducted upon admission and throughout a member’s continuum of care as they monitor progress and assist in determining if the individual is ready to move to a less restrictive environment or if they need continued support at the current level of care. This ensures that treatment remains appropriate as the member progresses through their recovery. 

How to submit requests for authorization

Submit complete and up-to-date documentation to support your authorization requests. 

Psych/Neuropsych Testing 

Complete and submit the Optum Psych Testing Form

TMS Services

Use the Provider Express secure portal

1. Log in to the secure portal with your One Healthcare ID and password
2. Select Auths > Auth Request > Request a New Authorization > TMS 

Medical necessity
The length and approval of authorizations are often based on medical necessity.

• Standard clinical criteria
• Supplemental Clinical Criteria: Optum Psych/Neuropsych Testing

Note: If we are unable to reach you, our clinicians will leave Protected Health Information (PHI) and authorization details if you have a voicemail greeting indicating the voicemail box is HIPPA compliant, confidential and secure. 

How to submit requests for authorization

• Review and complete the steps outlined on the Kentucky ABA webpage.
• Submit complete and up-to-date documentation to support your authorization requests.
• Then submit a request through the Provider Express Secure Portal
  • Log in to the secure portal with your One Healthcare ID and password
  • Select Auths > Auth Request > Request a New Authorization > ABA Assessment and Treatment

Medical Necessity

The length and approval of authorizations are often based on medical necessity.

Optum has adopted the InterQual® Care Guidelines for guidance on clinical criteria decisions for the treatment of behavioral health conditions for Kentucky Medicaid membership.  The InterQual® criteria Care Guidelines are proprietary to InterQual® and are not published.

Documentation

Submit complete and up-to-date documentation to support your authorization requests. 

Frequently asked ABA prior authorization questions: 

When can we start getting prior auths for ABA?

Please email your provider advocate, Melanie Bishop, at melanie.r.bishop@uhc.com.

How do members follow up with prior auth questions?

Members should call the member services phone number on the back of their insurance card. 

If there is an auth on file, customer service should be able to provide information.  If no auth is found, the member should contact the requesting ABA provider to confirm submission.

Can providers get a soft transfer to the appropriate prior auth agency?

Yes. When providers speak with customer service for a prior auth inquiry, they can be transferred to the clinical ABA team for a phone review.

Most providers submit requests using the Provider Express secure portal. 

How to submit requests for authorization

Submit complete and up-to-date documentation to support your authorization requests. 

1. Complete the Kentucky Community-Based Services Request Form
2. Then submit a request through the Provider Express Secure Portal
   • Log in to the secure portal with your One Healthcare ID and password
   • Select Auths > Auth Request > Request a New Authorization 

Medical Necessity

The length and approval of authorizations are often based on medical necessity.

• Kentucky Medicaid – Supplemental Clinical Criteria

Documentation

Submit complete and up-to-date documentation to support your authorization requests. 

Community-based Services

Needs Assessment

Optum requires the most recent needs assessment. If the member's clinical presentation has changed, the assessment and treatment plan should be updated to reflect the changes. The assessment will serve as documentation of medical necessity.

LOCUS/CALOCUS/CANS/CASII

Optum does not have a preference for specific assessments (LOCUS, CALOCUS, CANS, CASII), except for ACT. 

For ACT, please use LOCUS.

Non-Medicaid Authorization Requests

Retroactive requests are submitted in writing to:

Optum Behavioral Health Solutions 
Attn: National Appeals Department
P.O. Box 30512
Salt Lake City, UT
84130-0512
Fax: 1-855-312-1470

If you have any questions, please call 1-866-556-8166.