Behavioral Health
Banner University Health Plans (BUHP) is committed to the facilitation and coordination of care for members to ensure optimal integrated care. Many of our members have complex behavioral health and physical health conditions that require multiple providers to communicate their treatment approaches and interventions to improve the member’s care.
BUHP’s providers are expected to respond and participate in these care coordination activities and are encouraged to contact us if there care coordination concerns.
Crisis Management and Services
The information below can be utilized by any of our members.
For members living in Gila and Maricopa:
- Crisis Response Network: (877) 756-4090
For members living in Cochise, Graham, Greenlee, La Paz, Pima, Pinal, Santa Cruz, and Yuma:
- Crisis Line (NurseWise): (866) 495-6735
Other Resources:
- National Suicide Prevention Lifeline Hotline
- (800) 273-TALK (8255)
- Spanish-language Hotline: (888) 628-9454
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Hearing & Speech Impaired with TTY Equipment: 1-800-799- 4TTY (4889)
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24/7, free & confidential, available to anyone in emotional distress
Important Contact Information
Customer Care Center
Banner – University Family Care/ACC: (800) 582-8686, TTY 711
Banner – University Family Care/ALTCS: (833) 318-4146, TTY 711
Banner – University Care Advantage: (877) 874-3930, TTY 711
Crisis Response Network (CRN)
(800) 631-1314
(Please call this number if you are in one of the following counties: Maricopa, Yavapai, Mohave, Coconino, Apache, Navajo and Gila)
Nurse-On-Call
(888) 747-7990 , TTY 711
Behavioral Health Materials and Forms
AMPM Exhibit 320-U-1, Application for Involuntary Evaluation
AMPM Exhibit 320-U-2, Application for Emergency Admission for Evaluation
AMPM Exhibit 320-U-3, Petition for Court-Ordered Evaluation
AMPM Exhibit 320-U-4, Petition for Court-Ordered Treatment Gravely Disabled Person
AMPM Exhibit 320-U-5, Affidavit
AMPM Exhibit 320-U-7, Application for Voluntary Evaluation
Behavioral Health Prior Authorization Form
Behavioral Health - Utilization Management Grid
Court Order Treatment Plan Generic Template
Court Ordered Treatment Plan - Individual
Court Ordered Treatment Status
Decline to Participate in Eligibility Verification Screenings
Informed Consent for Psychotropic Medication Treatment
Law Enforcement Committal Information Form
Minimum Laboratory Monitoring for Psychotropic Medications
Notification of Individual's Right to Request Judicial Review and Right to Speak to Legal Counsel
Notice of Filing Confirmation of Receipt
Out of Home Admission Application
Out of Home Admission Notification
Out of Home Discharge Summary Form
PCP Referral to Behavioral Health Provider (Overview and Form)
Pharmacy Prior Authorization Request Form
Provider Checklist for Prior Authorization for Neuropsychological Testing
Provider Court Order Treatment Roster Template
Psychiatric Examination for Annual Review of Gravely Disabled Person
Psychiatric Examination for Annual Review of Persistently or Acutely Disabled
Release from Court Order Treatment Worksheet