- Authorization for Disclosure of Protected Health Information Form
- Appointment of Authorized Representative for Appeal Form (PDF)
- Member Claim Form (PDF)
- Postpartum Checkup Incentive Form (PDF)
Forms in MyChart
Get secure and convenient access to member forms and resources through MyChart.
Outreach Specialists and Case Managers can help you with:
- Coordinating Care
- Getting Health Care
- Health and Wellness
Contact Customer Service if you have questions about:
- Quartz ID cards
- Doctors or nurses
Appeals u0026 Grievances
You or your authorized representative may request an initial decision or appeal. Your prescriber or treating provider may also request it for you.