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Service Authorization are on hold until the end of the Federal Public Health Emergency.

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

Service Authorization Fillable Forms

To submit Service Authorization forms via fax, please send to: 1-844-881-3753

Appeals Form