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

Behavioral Health Prior Authorization Form

Behavioral Health - Utilization Management Grid

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

Out of State Placement Form

PCP Referral to Behavioral Health Provider (Overview and Form)

PCP Screening and Assessment Tools for Behavioral Health

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

Recertification of Need (RON)

Release from Court Order Treatment Worksheet

Request for Suspension of Outpatient Treatment Plan

SMART Goals

Transfer Request Form

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.