Monthly updates will be added to the Prior Authorization list. Providers are reminded to review the Prior Authorization list on a regular basis for any updates or changes which may be added.
Please contact Customer Service with specific code information to determine if an item or service requires prior authorization.
Prior authorization is required for clinic-administered medications listed below. Practitioners must submit a prior authorization request via MyPlanTools or fax a Medication Prior Request Form to Quartz at (888) 450-4711.
View the applicable PA Criteria by clicking the appropriate button below.