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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

ProHealth Medicare Advantage (HMO) from Quartz 

Elite Exclusion List

UW Health Medicare Advantage (HMO) from Quartz 

Elite Exclusion List

Value Exclusion List

Other Forms

Provider Participation Request Form

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)


Join Our Network

Fill out the Provider Participation Request Form; then,

Chiropractic Providers

Fulcrum Health, Inc., contracts for chiropractors on behalf of Quartz Medicare Advantage.

Durable Medical Equipment, Home Health and Infusion Therapy Providers

  • Contact Chartwell at (608) 831-8555 or (800) 730-8555 for your DME, home health or infusion therapy needs.

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 June 2, 2020.