You or your authorized representative may request an initial decision or appeal. Your prescriber or treating provider may also request it for you. Use the contact information below.
For information on how to authorize a representative during an appeal, see the Appointment of Representative document (Form CMS-1696 08/18).
For a complete description of these processes, refer to your Evidence of Coverage (EOC).
For more information about Medicare Part D prescription drug limitations and exceptions, please refer to the Quartz Medicare Advantage Part D Formulary. The formulary also provides information about prescriptions that require prior authorization, quantity limits, or step therapy.
Check on the status of a request or grievance
You may also check on the status of a request or grievance by calling one of the numbers listed below.
How to request a report
You can request a report on the total number of grievances, appeals, and exceptions filed with Quartz Medicare Advantage by calling Customer Service or sending a written request to our Customer
Service Department at the address listed below.