Department of Medical Assistance Services
Service Authorization / Registration
ARTS LOGO



Service Authorization ARTS SERVICE AUTHORIZATION FORMS FOR ASAM LEVELS 2.1/2.5/3.1/3.5/3.7/4.0 - CCC PLUS ADDED
Bullet Point Image ARTS Initial Service Authorization Request Form - word fillable

Bullet Point Image ARTS Extension Service Authorization Request Form - word fillable

Bullet Point Image Provider Qualification Requirements for ARTS – Who Can Complete What

ARTS Substance Use Case Management Registration Form
Bullet Point Image Magellan Registration Form including Substance Use Case Management

Bullet Point Image ARTS Registration Form for Substance Use Case Management for MCOs, CCC and CCC Plus Contacts

Pharmacy Service Authorization Forms
Bullet Point Image Managed Care Plan Preferred/Formulary for the Treatment of Opioid Use Disorder

Bullet Point Image DMAS Pharmacy Service Authorization Forms

Bullet Point Image Buprenorphine Implant Service Authorization Form

ARTS PEER SUPPORT SERVICE REGISTRATION / SERVICE AUTHORIZATION FORM
Bullet Point Image Magellan Registration Form for ARTS and Mental Health Peer Support Services

Bullet Point Image Health Plan ARTS Peer Support Services Registration Form

Bullet Point Image Additional Information Needed by Health Plans to Submit with Registration Form

Bullet Point Image Service Authorization Notification Process by Health Plan and Magellan of Virginia