High call volumes

Our member and provider services may be experiencing higher than normal call volumes. We encourage you to utilize alternative forms of communication including secured messaging through online Member Services and Availity Essentials Provider Portal.

Phones unavailable today 330-5pm CST today

Please be advised that the CCC member phones are coming down at 3:30-5pm CST today.

We are unable to accept walk-ins on Friday, Jan. 2., due to short staffing.

Medicaid Expansion Crisis Line Utilization Form

Please complete the following form for any Medicaid Expansion Member utilizing the Crisis Line to access the Mobile Crisis Team, the Emergency Room or Detox.

Member

* Required fields

Member First Name

Member Last Name

Member Date of Birth

The date does not appear to be correct. Please try again.

Member ID Number

Member Phone Number

Case Management Referral Yes

Summary of the Member's Needs

Submitter

Submitter First Name

Submitter Last Name

Submitter Contact Number

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Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121

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Medicaid Expansion Crisis Line Utilization Form