SMI Provider

Provider Submission Portal

  • 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.

Forms

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

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SMI Determination

FAQ’s

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 can I improve the success of a clinical staffing conducted regarding my members undergoing the SMI determination process?

– Provide more than one clinical contact.
– Provide accurate contact information for clinical contacts.
– Clinical contacts ought to be the clinicians who are most familiar with the member’s day-to-day functioning.
– Take note of potential upcoming vacation time for the clinical contact. Provide a backup contact if they are to be out.
– Ensure your voicemail is accepting messages and has a clear greeting identifying that it is your line.
– Return clinical staffing messages within 24 hours maximum. CRN has very limited time to render a decision!
– Indicate the best method to be reached (email/phone).
– Provide your accurate, honest perspective in the evaluation packet.

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

If you would like to be assessed for SMI services, please contact your assigned AHCCCS Complete Care (ACC) Plan. Your ACC Plan or provider will then arrange for a qualified assessor to meet with you and complete an application for SMI services:

Arizona Complete Health 1-800-788-4408
Banner University Family Care 1-833-318-4146
Care 1st 1-602-778-1800
Magellan Complete care 1-800-424-5891
Mercy Care 1-602-263-3000
Steward Health Choice Arizona 1-800-322-8670
United Healthcare Community Plan 1-800-348-4058
Gila River Behavioral Health Services 1-888-484-8526
Navajo Nation 1-928-871-6235
White Mountain Apache Behavioral Health Services 1-928-338-4811

 

If you are not currently assigned to an ACC Plan, contact the T/RBHA in your region:

Northern Arizona:

Central Arizona:

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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Fraud

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.

Provider Training

Click here to enter the Training Portal

Policies

ECS 1.01 Initial Submission to CRN 1.8.19

ECS 2.01 Criteria for SMI Eligibility 3.14.19

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 Process 7.18.19

ECS 3.01 Appeals and Notices Requirements 12.18.19

ECS 4.02 Release of Information 3.14.19

ECS 5.01 Record Requirements 3.14.19

ECS 11.02 SMI Evaluation and Packet – Data Quality and Training Requirements 12.18.19


If you have any questions about the ECS Provider Dashboard or wish to schedule a training on the SMI Packet Submission Process, please email the ECS team at SMItraining@crisisnetwork.org or call 855-832-2866.