Virginia Authorization Forms

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 Requests - electronic submission (commercial ABA providers only)
• ABA Treatment Plan - electronic submissions
• To download, click DMAS VA MHS Forms
  

VA MHS Request Form

• VA MHS Request Form - electronic submission
  

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

  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.
  

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