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Member Prior Authorization Resources:
General List
General List
We work closely with our provider owners to minimize prior authorizations as much as possible. Please review your plan’s specific prior authorization list below.
Call Customer Success for support: (800) 362-3310
Prior authorizations under your health plan
Below is a list of in-network prior authorizations currently required under your health plan. We’re always working to minimize these requirements and regularly update this list.
If you are out of network, you will need to contact Quartz by calling customer success for help with out of network care. Call us at (800) 362-3310.
- Experimental and Investigational Treatments
- In-home Therapy
- Partial Hospital Program (PHP)
- Residential Treatment
- Transcranial Magnetic Stimulation (TMS)
- Vagus Nerve Stimulation
All equipment rentals and any purchased items in excess of $500 in billed charges require prior authorization.
Note: Urgent/emergent hospital admissions require notification at the time of admission. Elective hospital admissions require prior authorization before admission and notification when admitted.
- Hospitals, Acute Inpatient Care
- Inpatient Rehabilitation Facilities
- Long-Term Acute Care Hospital (LTACH)
- Psychiatric Admissions
- Skilled Nursing Facility/Swing Bed
Prior authorization is required for the clinic-administered medications listed below:
- View the clinic administration medication list
- View the medical benefit PA criteria library
- View additional resources for medical benefit medications
For patients that have pharmacy coverage through Quartz, prior authorization is required for the prescription medications listed in the prescription benefit PA criteria library.
Quartz pharmacy criteria – Large Group – Small Group/Individual
Note: The following procedures must receive prior authorization before they can be scheduled.
- Bariatric Surgery
- Gender Reassignment Surgical Procedures
- Implantable Nerve Stimulators
- Laser Re-surfacing for Non-cosmetic Procedures (cosmetic procedures are excluded)
- Laser Treatment of Actinic Keratosis or Other Benign Skin Lesions
- Left Ventricular Assist Devices (LVAD) for Treatment of Heart Failure
- Orthognathic Surgery
- Orthopedic Procedures (including artificial cervical and lumbar disc surgery and OATS procedures)
- Panniculectomy
- Removal of Port Wine Stains and Hemangiomas
- Rhinoplasty and Septorhinoplasty
- Scar Revision and Repair (cosmetic procedures are excluded)
- Surgical Treatment of Obstructive Sleep Apnea
- Temporomandibular Joint Disease Surgical Treatment
- Transplants, including donor and other related charges (excludes corneal, except for artificial corneal transplants)
If you are out of network, prior authorization is needed for non-emergency care received. Contact Customer Success at (800) 362-3310 for help.
- Ambulance Services (non-emergent/urgent)
- CAR T Cell Therapy
- Custom Shoes and Custom-molded Orthotics (including orthopedic shoes)
- Experimental and Investigational Treatments
- Fractional Flow Reserve Calculation after Coronary CT Angiography (FFR-CT)
- Genetic Testing
- Home Health Care (including home infusion services and other in-home therapy services)
- Hospice Care
- Hyperbaric Oxygen Therapy
- Palliative Care
- Proton Beam Therapy
- Treatment of Urinary and Fecal Incontinence
- Bioengineered Skin Substitutes
Contact us
Quartz is here to help. That’s why we make it easy to reach us.
Call Quartz Customer Success (844) 644-3455 or message us on Quartz MyChart.