Prior Authorization

  • October 22, 2018
  • |Quartz
|
This is a blog post. The information may not be up-to-date. Please contact Customer Service
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When your doctor or care provider prescribes drugs, orders tests or advises care with a specialist, you might first need a prior authorization.

Your doctor or nurse will send the prior authorization form to one of three utilization management teams at Quartz who work with Quartz members and doctors through the entire prior authorization process.

About the Utilization Management Teams

The utilization management teams have special training and decide if the service can be covered by your insurance. The three utilization management teams are – 

  1. UW Health Medical Management
  2. UW Health Behavioral Health Care Management
  3. Quartz Pharmacy Program

When the utilization management teams receive a prior authorization request, they look at a lot of information before deciding if it is approved. All the teams work together to make sure that members get consistent and fair benefit decisions within their insurance plan.

Questions about a Prior Authorization?

Only certain services require a prior authorization. Some services need a prior authorization even if you’ve had them before. Please contact Quartz Customer Service –

  • To find out if you will need a prior authorization
  • If you would like to discuss a decision that has been made and your appeal rights.

Learn more.

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