Behavioral Health

Banner – University Health Plans (B – UHP) 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. 

B – UHP’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
    • Hearing & Speech Impaired with TTY Equipment: 1-800-799- 4TTY (4889)

    • 24/7, free & confidential, available to anyone in emotional distress

    • http://www.suicidepreventionlifeline.org


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

PDF Icon AMPM Exhibit 320-U-1, Application for Involuntary Evaluation

PDF Icon AMPM Exhibit 320-U-2, Application for Emergency Admission for Evaluation

PDF Icon AMPM Exhibit 320-U-3, Petition for Court-Ordered Evaluation

PDF Icon AMPM Exhibit 320-U-4, Petition for Court-Ordered Treatment Gravely Disabled Person

PDF Icon AMPM Exhibit 320-U-5, Affidavit

PDF Icon AMPM Exhibit 320-U-7, Application for Voluntary Evaluation

PDF Icon Behavioral Health Prior Authorization Form 

PDF Icon Behavioral Health - Utilization Management Grid

PDF Icon Certification of Need (CON)

PDF Icon Concurrent Inpatient Review Form

PDF Icon Court Order Treatment Plan Generic Template

PDF Icon Court Ordered Treatment Plan - Individual

PDF Icon Court Ordered Treatment Status

PDF Icon Decline to Participate in Eligibility Verification Screenings 

PDF Icon Informed Consent for Psychotropic Medication Treatment

PDF Icon Initial Facility Inpatient Review Form

PDF Icon Law Enforcement Committal Information Form

PDF Icon Minimum Laboratory Monitoring for Psychotropic Medications

PDF Icon Notification of Individual's Right to Request Judicial Review and Right to Speak to Legal Counsel

PDF Icon Notice of Filing Confirmation of Receipt

PDF Icon Out of Home Admission Application

PDF Icon Out of Home Admission Notification

PDF Icon Out of Home Concurrent Review

PDF Icon Out of Home Discharge Summary Form

PDF Icon Out of State Placement Form

PDF Icon PCP Referral to Behavioral Health Provider (Overview and Form)

PDF Icon PCP Screening and Assessment Tools for Behavioral Health

PDF Icon Pharmacy Prior Authorization Request Form

PDF Icon Provider Checklist for Prior Authorization for Neuropsychological Testing

PDF Icon Provider Court Order Treatment Roster Template

PDF Icon Psychiatric Examination for Annual Review of Gravely Disabled Person

PDF Icon Psychiatric Examination for Annual Review of Persistently or Acutely Disabled

PDF Icon Recertification of Need (RON)

PDF Icon Release from Court Order Treatment Worksheet 

PDF Icon Request for Suspension of Outpatient Treatment Plan

PDF Icon Transfer Request Form

PDF Icon VR Member Referral Tracking Grid


Best Practice Guidelines

Primary care physicians, specialists and other health care providers are expected to use best practice guidelines in a way that promotes the achievement of desired member outcomes. Best practice guidelines provide research-based knowledge that is intended to work in collaboration with clinical guidelines and service delivery. Best practice guidelines enhance service delivery by ensuring member focused treatment while helping to bridge evidence-based clinical practice research with individualized treatment planning. Our best practice guidelines support in identifying, collecting, evaluating and implementing practices that aid in service delivery that supports member-centered interventions and desired outcomes. 

Click Here for additional information and resources on best practice guidelines.