FORMS

Service 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.

Global Distress Scale

The Optum Wellness Assessment is an integral part of the Alaska Clinical Model.  Analyses demonstrate that the Wellness Assessment scales, comprised of items from well-validated public domain scales, are both valid and reliable. Both have been independently validated to ensure psychometric integrity as an outcome tool and to affirm the tool's use as an objective assessment tool with external credibility. For additional detail of the Global Distress Scale, its reliability and validity, please click on the link below:

Global Distress Scale