Effective May 12, 2023, CMS granted approval for the Disaster State Plan suspending State Plan Service Authorizations retroactively and until May 11, 2024.
8.1.23 Suspension of Service Authorizations for Specific State Plan Services
CMS has granted expansion approval under the Disaster State Plan to suspend 1115 Waiver Service Authorizations retroactively and until May 11, 2024 OR regulation changes are finalized.
8.24.23 Suspension of Service Authorizations for 1115 Waiver Services
Optum will not be accepting any service authorizations, retrospective reviews or first level clinical appeals during this time.
Service Authorization Request Forms
Service authorizations are required for all services after participant state fiscal year limits have been exhausted. Providers can submit service authorizations either through an Online Portal or by completing a PDF and faxing to Optum. Providers are encouraged to use the forms used on this webpage as form versions may change.
Service Authorization Online Submissions
*Please ensure firstname.lastname@example.org is a safe approved email in order to receive your verification code to re-enter a Service Authorization form.
Service Authorization Fillable Forms
Due to the Disaster State Plan suspension, Optum will not be accepting any service authorizations, retrospective reviews or first level clinical appeals during this time.
To submit Service Authorization forms via fax, please send to: 1-844-881-3753