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FORMS

Service Authorization Request Forms

The following forms are for services requiring prior authorization. Please complete and submit the request before providing the service to a member. 

On 2/15/2020, Optum Alaska began processing 1115 Waiver SUD Service Authorizations requests, for services on and after 2/15/2020. To request authorizations for services that occurred before 2/15/2020, please contact the Division of Behavioral Health. Always come to this page to assure you are utilizing the most current request form.