What is Prior Authorization?

Some services, procedures and medications must be approved by Quartz before they are covered. The process is called Prior Authorization.

General Prior Authorization

Some services and supplies covered by your insurance plan must have prior authorization. This means that you, your doctor or nurse must fill out a General Prior Authorization Request Form before you can have the treatment to determine if it will be covered.

The services that need Prior Authorization are based on the type of insurance plan you have.

Check your Quartz ID card to see what plan you have. It’s printed at the top of the card.

Based on your ID Card, you can see the list of items that require Prior Authorization based on the type of plan you have–

  • Health Maintenance Organization (HMO)
  • POS
  • Medicare Select
  • Senior Choice
  • PPO – Extended Access

If you need one of the services on your plan’s Prior Authorization list, contact your doctor. Ask your doctor to fill out Quartz’s Prior Authorization Request Form.

Before you schedule your treatment, check to see if Quartz has approved the Prior Authorization.

Just login to MyChart or contact Customer Service at (800) 362-3310.

Medication Prior Authorization

Certain medications require a Medication Prior Authorization.

Medication PA Requests are reviewed by pharmacy staff using criteria set by Quartz’s Pharmacy and Therapeutic (P&T) Committee. If more information is needed, Quartz will contact your doctor or nurse. In that case, the decision and notice may take up to 15 days.

Learn more about Medication Prior Authorization

HMO Members

Use only in-network services and supplies. All out-of-network services and supplies must have Prior Authorization. Quartz checks out-of-network Prior Authorization requests to see if the service is needed based on medical review.

Insurance plans have a range of limitations and services or products that are excluded.

If Quartz approves a Prior Authorization, services are covered up to the usual, customary and reasonable charge (UCR).

You may be responsible for paying charges that are above the UCR and other out-of-pocket costs.

Behavioral Health and AODA Services

For assistance coordinating your behavioral health services, including alcohol and drug treatment services, please contact Behavioral Health Care Management at (608) 422-8380 or toll free at (800) 683-2300.

Hospital Services

For elective (non-emergency) services where you will be admitted to the hospital, the doctor who will admit you must contact Quartz for prior authorization and approval. If the hospital is not in Quartz’s network, please notify Quartz Customer Service.

Please access your plan's Prior Authorization List above to see if the health care service you are seeking requires prior authorization.


Questions?

Get in touch with Quartz Customer Service by sending a secured message through MyChart.