• For assistance or help with the SMI Assessment Provider Portal, please call 480-486-5365.
• 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.If this form is not submitted, the determination will be made in three days. (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

• Attestation Form
• Decertification Policy

Tips – Helpful Hints

• Inpatient Consideration for SMI Referrals
• Jail, Probation, Mental Health Court; Consideration for SMI Referrals
• GMH-SA Considerations for Submission of SMI Evaluations
• Considerations for Referring Someone for an SMI Evaluation

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, Office of Inspector General: 602-417-4193. For more information visit the AHCCCS Contacts page here.

Click here to enter the Training Portal

ECS 1.01 Initial Submission to CRN 1.8.19

ECS 2.01 Criteria for SMI Eligibility 3.1.18

ECS 2.01A SMI Qualifying Diagnosis 031617

ECS 2.01B Substance Use and Psychiatric Symptomatology Table

ECS 2.02 SMI Eligibility Determination Process 1.9.19

ECS 2.03 Decertification 6.11.18

ECS 3.01 Appeals and Notices Requirements 11.19.18

ECS 4.02 Release of Information 3.1.18

ECS 5.01 Record Requirements 3.1.18

ECS 11.02 SMI Evaluation and Packet – Data Quality and Training Requirements 8.22.18