Prior Authorization Forms and Policies

Pre-authorization fax numbers are specific to the type of authorization request. Please submit your request to the fax number listed on the request form with the fax coversheet.

Pre-authorization reconsideration request? Please submit the Reconsideration of a Denied Pre-Authorization form.

Advanced Imaging

Authorization Request

Behavioral Health

Community Mental Health Recovery Services (CMHRS)

Durable Medical Equipment (DME)

Home Health

Inpatient/Outpatient Observation

OB/GYN

Private Duty Nursing

Radiology and Oncology

Therapy Authorization Worksheet

Transitional Care Request

Urgent Request

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Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Optima Health Plan. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. Optima Health Medicare, Medicaid, and FAMIS programs are administered under agreements with Optima Health and the Centers for Medicare and Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS).