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Medicare Advantage Providers

To request a prior authorization or for questions about benefits, eligibility or claims status, contact Customer Service at (800) 394-5566 or TTY 711.

To submit a request to join our network, complete the Provider Participation Request Form and send it to

Benefit Denial Forms

Quartz Medicare Advantage Benefit Denial Form Instructions

Dental Services English | Spanish

DME & Supplies English | Spanish

General Use English | Spanish

Podiatry Services

Swing Bed Care (Qualifying 3-day Stay Not Met) English | Spanish

Skilled Nursing Facility Care (Qualifying 3-Day Stay Not Met)

Benefit Plan Exclusion Lists

Gundersen Medicare Advantage (HMO) from Quartz

Elite & Value Exclusion List

UW Health Medicare Advantage (HMO) from Quartz 

Elite Exclusion List

Value Exclusion List

Other Forms

Non-Contracted Provider Payment Appeal Process

Non-Contracted Provider Waiver of Liability

Claim Reopening Request Form

Claim Adjustment Form

Coding Denial Appeal Form
(used when there is a request for review of coding-related denial with an explanation of why provider feels it is coded correctly or when there is a request of Appeal of Coding denial with explanation & supporting documentation. A claim should not accompany this form)


Claims Submission Address:

Quartz Medicare Advantage Claims
PO Box 211221
Eagan, MN 55121

Electronic Payor ID# 66705

Provider Portal

Please log in here to access My Quartz Tools, our Provider Portal. 

You can reach a provider representative by calling Customer Service at (800) 362-3310.

This webpage was updated on March 28, 2021.