Most Quartz members do not need to get a Prior Authorization from their primary care provider (PCP) for in-network specialty care.*
If your PCP wants to send you to a doctor or nurse who is not in the Quartz network, a Prior Authorization Request Form must be filled out. These requests are only approved if Quartz’s in-network providers do not offer the service. (Learn more about Prior Authorizations).
To learn about your benefits, login to MyChart and check your –
Determine costs you may incur prior to receiving health care services using the Determination of Benefits Form in MyChart. To complete the form, you will have to ask your provider for certain medical coding information including procedure codes, procedure modifiers and unit codes for the services.
POS and PPO plans offer members the choice to stay in-network or go out-of-network for services.
For assistance coordinating your behavioral health services, including alcohol and drug treatment services, please contact Quartz – Behavioral Health Care Management at (608) 640-4450 or toll free at (800) 683-2300.
For elective (non-emergency) services where you will be admitted to the hospital, the doctor who will admit you must contact Quartz for prior authorization and approval. If the hospital is not in Quartz’s network, please notify Quartz Customer Service.
Please access your plan's prior authorization list to see if the health care service you are seeking requires prior authorization.
