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Service authorization forms — sometimes called prior authorization or preservice authorization forms — are official documents that healthcare providers submit to Medicaid agencies or managed care plans before delivering certain services. Their purpose is to establish medical necessity and secure approval for the type, amount, and duration of care a patient will receive. Without an approved authorization, services may be denied for reimbursement, making these forms a critical step in the care delivery process. The forms in this category focus primarily on behavioral health services, including Applied Behavior Analysis (ABA) therapy and residential behavioral health programs.
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About service authorization forms
These forms are typically completed by licensed clinicians, behavioral health providers, and administrative staff at treatment facilities or community mental health programs. Common situations include requesting initial authorization before ABA therapy begins, submitting concurrent authorizations to continue an ongoing treatment plan, or seeking approval for residential or personal care services under state Medicaid programs. For example, Virginia DMAS requires separate forms for preservice, initial, and concurrent ABA authorizations, while Oregon's CH-006 form handles plan-of-care requests for behavioral health residential services.
Because these forms are detailed — capturing diagnosis codes, CPT codes, service units, treatment goals, and clinical justifications — they can be time-consuming to complete accurately. Tools like Instafill.ai use AI to fill these forms in under 30 seconds, helping providers reduce administrative burden while keeping sensitive member data handled securely.
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How to Choose the Right Form
Not all service authorization forms serve the same purpose — the right one depends on your state, program, and stage of treatment. Here's how to narrow it down quickly.
Virginia Medicaid ABA Services (DMAS Forms)
These three forms are all issued by the Virginia Department of Medical Assistance Services (DMAS) for Applied Behavior Analysis therapy. Choose based on where you are in the treatment timeline:
- Starting treatment for the first time? Use the ABA Initial Service Authorization Request Form (97155, et al.). This is for new prior authorization requests and must be signed by an LMHP or LABA attesting to medical necessity.
- Continuing treatment for an enrolled member? Use the ABA Concurrent Service Authorization Request Form (CPT Codes 97153–97158, 0373T). This form demonstrates ongoing medical necessity and requires an updated Individual Service Plan and progress summary.
- Requesting authorization on or after September 1, 2025 — before services begin? Use the ABA Preservice Service Authorization Request Form (Effective 09/01/2025 and after). This updated form covers preservice (prior) authorization and retro review under the same CPT code range.
> Tip: The Concurrent and Preservice forms both cover CPT codes 97153–97158 and 0373T, but the Preservice form is specifically for *new* requests under the updated 2025 guidelines.
Oregon Behavioral Health Residential or Personal Care Services
If you're outside Virginia or working with a different program entirely, you may need:
- Form CH-006 (PA-BH-Res-PCS) — for Oregon providers or Community Mental Health Programs (CMHPs) requesting authorization for 1915(i) behavioral health residential or personal care services. Use this for initial authorizations, 90-day SRTF reauthorizations, change-in-condition assessments, or annual redeterminations.
Bottom line: Match your form to your state, the CPT codes involved, and whether you're initiating, continuing, or updating a service authorization.
Form Comparison
| Form | Purpose | Who Files It | When to Use |
|---|---|---|---|
| The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after) | Request prior authorization for ABA services before delivery | ABA providers billing Virginia Medicaid | Before ABA services begin (or retro review) |
| Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization | Authorize behavioral health residential or personal care services | Oregon providers and Community Mental Health Programs | Initial, reauthorization, change-in-condition, or annual redetermination |
| Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form | Obtain initial Medicaid authorization for ABA therapy services | LMHP or LABA providers in Virginia | First-time authorization request for new ABA members |
| Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services | Continue Medicaid authorization for ongoing ABA therapy | ABA providers with members currently enrolled in treatment | Reauthorization for members already receiving ABA services |
Tips for service authorization forms
Service authorization forms require detailed supporting documents such as Individual Service Plans, progress summaries, and diagnostic records. Having these ready before you begin filling out the form prevents delays and ensures you can accurately complete all clinical sections without interruption.
ABA service authorization forms are often specific to whether you are requesting initial, concurrent, or preservice authorization, and each covers distinct CPT codes (e.g., 97153–97158, 0373T). Submitting the wrong form type can result in denial or processing delays, so confirm you have the right form before completing it.
Reviewers like DMAS and Comagine Health evaluate each request against specific medical necessity criteria, including communication, behavioral, and sensory challenges. Vague or incomplete clinical narratives are a leading cause of authorization denials, so be as specific and evidence-based as possible in every relevant field.
AI-powered tools like Instafill.ai can complete service authorization forms in under 30 seconds with high accuracy, saving providers significant administrative time — especially when managing multiple authorization requests at once. Your data stays secure throughout the process, and Instafill.ai can even convert non-fillable PDF versions into interactive forms.
Some forms, such as the DMAS ABA forms, have specific effective dates (e.g., on or after 09/01/2025) and older versions may no longer be accepted. Always confirm you are using the current version of a form before submitting to avoid rejection due to an outdated document.
Many service authorization forms require attestation from a specific licensed professional, such as a Licensed Mental Health Professional (LMHP) or Licensed Applied Behavior Analyst (LABA). Submitting a form with the wrong signatory or a missing signature is a common and easily avoidable mistake that can delay approvals.
Concurrent and reauthorization requests (such as Oregon's 90-day SRTF reauthorizations) must be submitted before the current authorization period expires to avoid a gap in covered services. Build reminders into your workflow well in advance of expiration dates so you have time to compile documentation and submit without rushing.
Some forms, like the DMAS ABA Preservice form, require specific documentation when services are delivered via telemedicine. Failing to note this can cause billing issues or authorization mismatches, so always indicate the service delivery method accurately in the appropriate section.
Frequently Asked Questions
Service authorization forms — also called prior authorization or preservice authorization forms — are used to request approval from a payer (such as Medicaid or a managed care plan) before certain services are delivered. They allow the reviewing organization to assess medical necessity and approve the type, amount, and duration of services. Without an approved authorization, claims for those services may be denied.
Typically, licensed providers, clinicians, or Community Mental Health Programs (CMHPs) submit service authorization forms on behalf of the member or patient receiving services. For example, a Licensed Applied Behavior Analyst (LABA) or Licensed Mental Health Professional (LMHP) would complete and sign ABA authorization forms, while residential care providers would handle behavioral health residential authorization requests. The specific qualified professional required depends on the form and the services being requested.
A preservice (or prior) authorization is requested before services begin to establish medical necessity and get approval upfront. An initial service authorization is submitted when a member is first enrolling in a treatment program. A concurrent (or reauthorization) request is submitted while the member is already receiving services, to demonstrate continued medical necessity and obtain approval for ongoing treatment. Each stage typically requires different clinical documentation.
Virginia's Department of Medical Assistance Services (DMAS) offers separate forms depending on where a member is in their treatment. Use the Preservice Service Authorization Request Form (effective 09/01/2025 and after) for new requests before services begin, the Initial Service Authorization Request Form for a member's first enrollment in ABA therapy, and the Concurrent Service Authorization Request Form for members already receiving ABA services who need continued authorization. Selecting the correct form is essential to avoid processing delays.
The ABA service authorization forms in this category cover CPT codes 97153, 97154, 97155, 97156, 97157, 97158, and 0373T. These codes correspond to various levels and types of Applied Behavior Analysis services, including adaptive behavior treatment, protocol modification, and caregiver training. Always verify with your payer which specific codes require prior authorization before submitting.
Most service authorization forms require clinical documentation to substantiate medical necessity. This commonly includes DSM or ICD-10 diagnoses, an Individual Service Plan (ISP), treatment progress summaries, admission criteria assessments, and discharge planning details. For ongoing (concurrent) authorizations, updated progress notes and treatment outcomes are typically required alongside the completed form.
Submitting an incorrect or incomplete form can result in processing delays, requests for additional information, or outright denial of the authorization. It's important to match the form to the correct stage of care (preservice, initial, or concurrent) and the specific services being requested. Always check with the relevant Medicaid agency or managed care plan to confirm you are using the most current version of the required form.
Submission timelines vary by payer and program, but it is generally advisable to submit preservice and initial authorization requests well before the planned start of services to allow adequate review time. Concurrent authorization requests should typically be submitted before the current authorization period expires to prevent a gap in coverage. Check the specific program guidelines — such as those from DMAS or Oregon's Comagine Health — for exact submission windows.
Submission requirements vary by form and program. Virginia DMAS ABA forms are generally submitted to the relevant health plan or DMAS contractor responsible for utilization management. Oregon's behavioral health residential and personal care authorization form (CH-006) is submitted to Comagine Health along with required clinical documentation. Always refer to the instructions accompanying each specific form for the correct submission address, fax number, or portal.
Yes — AI-powered tools like Instafill.ai can fill out service authorization forms in under 30 seconds by accurately extracting and placing data from source documents such as clinical records or existing member files. This significantly reduces manual data entry time and the risk of errors on complex multi-field forms. Instafill.ai can also convert non-fillable PDF versions of these forms into interactive, fillable formats.
Manually completing a detailed service authorization form can take anywhere from 20 minutes to over an hour, depending on the complexity of the clinical information required. Using an AI tool like Instafill.ai, the same forms can be populated accurately in under 30 seconds by pulling relevant data directly from supporting documents. This allows providers to focus more time on patient care rather than administrative tasks.
Yes, most service authorization forms require a signature from a qualified clinical professional to attest that the member meets medical necessity criteria. For ABA-related forms, this is typically a Licensed Mental Health Professional (LMHP) or Licensed Applied Behavior Analyst (LABA). Oregon's behavioral health residential authorization form may require signatures from the provider and Community Mental Health Program (CHMHP) representatives. Unsigned or improperly signed forms are commonly rejected, so always verify signature requirements before submitting.
Glossary
- Service Authorization (SA)
- Approval from a Medicaid agency or health plan that must be obtained before certain services are delivered and reimbursed. Without an approved service authorization, claims for those services are typically denied.
- Prior Authorization (PA)
- A requirement that a provider get advance approval from the payer before rendering a specific service or treatment. It is used to confirm medical necessity and control costs before care begins.
- Medical Necessity
- A clinical standard used by Medicaid and health plans to determine whether a requested service is appropriate, reasonable, and required to treat a member's condition. Services that do not meet medical necessity criteria are typically denied.
- Applied Behavior Analysis (ABA)
- A therapy based on the science of learning and behavior, most commonly used to treat autism spectrum disorder (ASD) in children. ABA services require prior authorization under Medicaid and are billed using specific CPT codes (97153–97158 and 0373T).
- CPT Code
- Current Procedural Terminology codes are standardized numeric codes used to identify and bill specific medical, surgical, or therapeutic services. On these forms, CPT codes specify exactly which ABA or behavioral health services are being requested.
- Concurrent Service Authorization
- An authorization request submitted while a member is actively receiving services, used to demonstrate continued medical necessity and obtain approval for additional units or an extended treatment period.
- Individual Service Plan (ISP)
- A written document that outlines a member's treatment goals, the specific services to be provided, and the expected outcomes. It is typically required as supporting documentation when submitting a service authorization request.
- DMAS
- The Virginia Department of Medical Assistance Services, the state agency that administers Virginia's Medicaid and CHIP programs. DMAS reviews service authorization requests and sets the rules for covered ABA and other behavioral health services.
- 1915(i) State Plan Amendment
- A Medicaid authority that allows states to offer home and community-based services to individuals who meet specific clinical criteria, without requiring a waiver. Oregon's Behavioral Health Support Program referenced in Form CH-006 operates under this authority.
- LMHP / LABA
- Licensed Mental Health Professional (LMHP) and Licensed Applied Behavior Analyst (LABA) are credentialed clinicians authorized to assess members and attest to medical necessity on ABA service authorization forms. A signature from one of these professionals is typically required for the form to be valid.