FORMS

SERVICE REQUEST FORMS

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

Service Request Form Demo Video
Please view the following video for a demonstration of how to fill out the new Service Request Form, using the Adult CBRS form for demonstration purposes. Please note that the video will play the most clearly on Firefox, or the newest version of Internet Browsers. 

OTHER FORMS

Below are other forms that may be of assistance in helping Optum Idaho members.

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Provider Clinical Questions: (855) 202-0983  | PCP Psychiatric Consult press option 1