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

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

ASH Admissions Packet

Certification of Need (CON)

Concurrent Review Guide - Adult

Concurrent Review Guide - Children

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

Initial Facility Inpatient Review Form

Inpatient Transfer Request Form

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

OOH Between Facility Transfer Request

PCP Referral to Behavioral Health Provider Form

PCP Screening and Assessment Tools for Behavioral Health

Pharmacy Prior Authorization Request Form

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

Recertification of Need (RON)

Referral Prioritization for Meet Me Where I Am (MMWIA)

Release from Court Order Treatment Worksheet

Request for Suspension of Outpatient Treatment Plan

SMART Goals

VR Member Referral Tracking Grid

Court Ordered Evaluation (COE) and Court Ordered Treatment (COT)

What happens when an individual appears to be in need of psychiatric treatment but is unwilling or unable to consent to treatment? Under Arizona law (Title 36) a person eighteen years of age or older may be ordered by the court to undergo psychiatric evaluation and ordered into treatment. This can happen on an inpatient or outpatient basis. The documents on this page explain the legal process, answer some frequently asked questions, and provide additional resources to anyone who wants to learn more.