Quartz Updates – Winter 2021

Retroactive Authorization Policy Expanded

For services requiring authorization or referral, prior authorization must be obtained before the service is completed. If prior authorization is not obtained, the service will be denied, and no additional reviews will be done. This policy took effect for commercial products on August 15, 2020, and for Medicare Advantage products on January 1, 2021. Please refer to our website for services that require prior authorization.

Contacting Your Provider Coordinator

We recently updated our provider coordinator map and contact list. Please refer to this handy contact guide to reach the Quartz provider coordinator assigned to you.

Shingrix Vaccine Reminder

If you are administering Shingrix to patients with Medicare coverage, it will be denied under Part B. This vaccine is only covered under Part D. Unless you are set up to bill Part D plans, you should refer Medicare patients to a pharmacy for their Shingrix shots.

Claim Submissions

Claims need to be submitted within the timely filing limit stated within the provider’s contract language. Failure to submit claims within that specified time frame may result in nonpayment.

A healthcare professional prepares a vaccine for an elderly patient
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