Quartz’s mission is to investigate all grievances and appeals appropriately and work to resolve them within the required time period. The State of Minnesota’s definition of “Appeal” means a formal request, either orally or in writing, to reconsider a determination not to certify an admission, extension of stay, or other health care service.

There is a 180-day time limit for filing a pre-service appeal. Expedited appeals will be resolved in 72 hours and standard appeals will be resolved in 30 days. You or your provider can file an appeal.

Your provider will need your approval which can be submitted on the Appointment of Authorized Representative form.

In some cases, the State of Minnesota gives members the ability to file an external independent review upon completion of the internal appeal process. You may obtain the Request for External Appeal form by phone, email, or by submitting a written request.

• Appointment of Authorized Representative Form
• Appeal Filing Form
• Formulary Exception Request Form

Mail:
Minnesota Department of Health
Managed Care Systems Section
P.O. Box 64882
St. Paul, MN 55164-0882

Phone:
(651) 201-5100 or (800) 657-3916

Email:
[email protected].

There is a $25 fee for the external review. This fee will be refunded if the external review decision is in your favor.

The fee must be paid by check, made out to the Minnesota Department of Health.

The $25 fee may be waived in cases of financial hardship. You will need to explain why payment of this fee would be a hardship and provide this information with your case file.