Behavioral health prior authorization

Behavioral health services

Most outpatient mental health and substance use disorder services will not require prior authorization. Partial hospitalization, intensive outpatient, applied behavior analysis (ABA), transcranial magnetic stimulation (TMS) and psychological and neuropsychological testing will require prior authorization. Please see our Behavioral Health Prior Authorization List for more information. For authorizations and your provider related questions, please contact Optum Behavioral Health at 1-844-483-9013.

Behavioral health outpatient lab services

Sharp Health Plan is responsible for outpatient behavioral health laboratory services. Routine outpatient behavioral health labs do not require prior authorization.

Specialty lab requests, including genetic testing (i.e., behavioral health genetic labs to determine susceptibility to medications, etc.), require prior authorization from Sharp Health Plan.

For specialty lab requests, providers must complete the SHP Prior Authorization form and fax it to the SHP UM department at 1-619-740-8111.

• Commercial Prior Authorization form (PDF)
• Medicare Prior Authorization form (PDF)

SHP will communicate all findings to the provider after the review.