The following is not an all-inclusive list. Updates are periodically made to the Prior Authorization list. Providers are encouraged to review the Prior Authorization List frequently for changes.
Please contact Quartz Customer Service at (800) 805-0693 with specific code information to determine if an item or service requires prior authorization. Prior Authorization is not a guarantee of payment.
Prior authorization is required for clinic-administered medications. Practitioners must submit a prior authorization request via MyPlanTools or fax a Medication Prior Authorization Request Form to Quartz at (888) 450-4711.
The following procedures must be prior authorized before they are scheduled.