Member Prior Authorization Information
General Prior Authorization List – Quartz PPO (Cigna PPO Network*)
Members of a Quartz PPO Plan (Cigna PPO Network) are responsible for obtaining prior authorization in order to receive coverage for certain services. Check your Member ID Card for the Cigna PPO Network logo to see if this is your plan.
Before a patient receives a service that requires prior authorization, they must arrange for prior authorization through Quartz.
Please contact Quartz Customer Success at (800) 362-3310 with specific code information to determine if an item or service requires prior authorization. Prior authorization is not a guarantee of payment. Coverage is determined by the terms of a members’ benefit plan.
The following Prior Authorization List is not an all-inclusive list and will be updated periodically.
These services require Prior Authorization:
- Behavioral Health Services:
- Inpatient mental health hospital
- Mental health residential
- Inpatient substance abuse hospital
- Substance abuse residential
- Cochlear Implants
- Diagnostic Radiology
- Durable Medical Equipment
- Erectile Dysfunction
- Gastric Bypass
- Home Health Care
- Home Infusion Therapy
- Injectable Medications
- Acute Inpatient
- Acute inpatient rehabilitation
- Long term acute care hospital (LTACH)
- Skilled nursing facility
- Orthotics and Prosthetics
- Outpatient Procedures (select specialty outpatient procedures)
- Potential experimental and investigational
- Unlisted Procedures
To learn more about Cigna’s coverage policies, click here.
*The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna is an independent company and not affiliated with Quartz. Access to the Cigna PPO Network is available through Cigna’s contractual relationship with Quartz. All Cigna products are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.