Utilization Management

  • April 08, 2018
  • |Quartz
|
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All Utilization Management decision-making is based only on the appropriateness of care and services, and the existence of coverage.

UTILIZATION MANAGEMENT

All Utilization Management decision-making is based only on the appropriateness of care and services, and the existence of coverage. Practitioners, providers or other individuals are not specifically rewarded for issuing denials of coverage, service or care.

For more information on Quartz Utilization Management, visit QuartzBenefits.com/utilization.

MEMBER RIGHTS AND RESPONSIBILITIES STATEMENT

We are committed to maintaining a mutually respectful relationship with our members and practitioners. Our Member Rights and Responsibilities Statement communicates our respect for your rights and our expectations of your responsibilities, including your right to privacy and confidentiality, your right to be treated with respect and dignity and your responsibility to show consideration and respect to health plan staff and health care practitioners.

FORMULARY UPDATES*

Our Pharmacy and Therapeutics (P&T) Committees develop the prescription drug formularies for Quartz-branded health plans. Each P&T Committee includes physicians from various medical specialties, pharmacists and health plan staff who review medications in all therapeutic categories based on safety, effectiveness and cost.

For the most recent formulary changes, as well as Utilization Management Criteria, please see your plan’s formulary by logging in to MyChart or by entering your member number or group number on the Formulary Lookup at QuartzBenefits.com/drugformulary.

The complete formulary, a description of your plan’s different pharmacy benefit designs and copayment or coinsurance requirements and current prior authorization criteria are available at QuartzBenefits.com or in writing upon request by calling (888) 450-4884.

All pharmacy benefit information applies only to members with corresponding prescription drug coverage through their plans’ benefits. If you have questions, please contact Quartz Customer Service at (800) 362-3310.

*State and Local Government Members, please visit Navitus for information about your prescription drug benefits.

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