• For assistance or help with the SMI Assessment Provider Portal, please call 602-527-8115.
  • If you are unable to access the CRN SMI Web Portal, the Fax number to submit Assessments is: 844-611-4752.

Provider Submission Checklist

Please check that the following documents are included in the submission:

  • Consent For Assessment – (this must be signed and dated within one business day of submission of application to CRN), the assessment cannot be processed without this form signed and dated appropriately. (SPANISH: Consent For Assessment )
  • Seriously Mentally Ill (SMI) Determination Form – Part C Additional Addenda (this form must be signed by a licensed clinician), the assessment cannot be processed without this form signed and dated appropriately.
  • Core Assessment – (this must be dated within six months of the submission and cannot be a “part E”)
  • Waiver of three day Determination Form – Please note that applicants are encouraged to waive their right to a three day determination. Generally speaking, evidence suggests that additional time to review and pursue historical treatment records result in a positive outcome. (SPANISH: Waiver of three day Determination Form)
  • Demographic Form – It is helpful to have the most current address, phone number and other pertinent demographic information in order to most effectively communicate with the client and other involved parties through the determination process.
  • Releases of Information – It is helpful to have an ROI for the emergency contact or family members that the client would like us to be able to communicate with regarding their care/determination as well as any prior outpatient and inpatient providers if the client would like these records considered as part of the determination. (SPANISH: Releases of Information )
  • Any additional records that may support SMI Criteria
    • Evaluators should make applicants aware pending (asking) for additional time may improve the likelihood of being determined eligible for SMI services.

If determined to be eligible for SMI services, the T/RBHA will assign the applicant to an SMI clinic. Applicants can choose which clinic they would like to attend.

Decertification Forms

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SMI Determination

What does it mean to be determined SMI or eligible for SMI services?

Serious Mental Illness (“SMI”) is a description used in Arizona for people who need additional support because their mental illness impacts their ability to function.

What is looked at (criteria/qualifications) to diagnose someone or determine if they qualify for SMI services?

To be eligible for SMI services (to get an SMI determination) a person must have both an SMI diagnosis and functional impairment caused by the qualifying diagnosis.

How do I request/ask for an evaluation for SMI services?

If you are would like to be assessed for SMI services, please call your provider or local T/RBHA. Your T/RBHA or provider will then arrange for a qualified assessor to meet with you and complete an application for SMI services.

Northern Arizona:

Central Arizona:

  • Mercy Maricopa Integrated Care
    1-866-602-1979 (toll‑free)
    Hearing impaired TTY/TDD 711

Southern Arizona:

If you are already receiving services with an AHCCCS provider, you may ask your provider to submit an application for SMI services.

If you are a provider, you may submit applications through this website on the SMI Assessment Submission Portal page.

Notice of Privacy Practices

What if I don’t want SMI services anymore?

SMI services are voluntary. You may choose not to receive services. Or, you can ask your clinical team about closing or dis-enrolling.

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I called the National Suicide Hotline after hearing Logic's song. I was directed to a Crisis Specialist at Crisis Response Network. He saved my life. That's all there is to it.

– Crisis Line Caller

Reporting Fraud & Abuse

Members need to use behavioral health services properly. It is considered fraud if a member or provider is dishonest in order to:

  • Get a service not approved for the member.
  • Get AHCCCS benefits that a person is not eligible for.

Abuse happens if a member causes unnecessary costs to the system on purpose, for example:

  • Loaning an AHCCCS card or the information on it to someone else.
  • Selling an AHCCCS card or the information on it to someone else.

Misuse of your AHCCCS identification card, including loaning, selling or giving it to others, could result in your loss of AHCCCS eligibility. Fraud and abuse are felony crimes and are punishable by legal action against the member or provider.

CRN has a zero tolerance policy against fraud, waste and program abuse.

If you think somebody is committing fraud or abuse, please contact the AHCCCS Clinical Resolution Unit: 602-364-4558 or 1-800-867-5808. For more information visit the AHCCCS Contacts page here.





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