Prior Authorization Resources for Members
Customer success is here to answer your questions.
Call us at (800) 362-3310
Call us at (800) 362-3310
Helping you understand prior authorizations
Prior authorization is a process where Quartz works with your doctors to review certain medical services or prescriptions before they are provided.
Quartz works closely with your doctors to minimize prior authorizations. Because we are owned by doctors, we are in a unique position to reduce the need for prior authorizations for in-network services.
Customer Success is here to answer your questions. Call us at (800) 362-3310
Three steps for prior authorizations
1.
Do I need a prior authorization?
Your in-network doctor will know the services and medications that require prior authorization.
2.
How is it submitted?
If required, your doctor will submit the necessary forms for us to review.
3.
Is my prior authorization approved?
Quartz will review the prior authorization request and send you and your doctor a letter in the mail with our decision.
If you are out of network, prior authorization is needed for non-emergency care received. Contact Customer Success at (800) 362-3310 for help.
View prior authorizations required for your health plan
To view what procedures, services, or medication require prior authorizations on your health plan, please select your state and network below (your network is listed at the top of your member ID card).
Prior Authorization request forms
The below forms are to be completed by your health provider
Common questions
- Know your plan: Review your Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC) to understand authorization requirements. (do we need to tell them where to find this? I wouldn’t even know where to go for this. Is it in MyChart?)
- Start early and coordinate with your doctor: Make sure your doctor submits requests in advance and includes all necessary documentation to avoid delays.
- Keep records: Document communications for easy reference.
Prior authorization ensures that medical services, procedures, or medications are covered under your Quartz plan and medically necessary for your condition.
Check your Quartz member materials (SBC or EOC) or call Quartz Customer Service at (800) 362-3310 for assistance. You can also use the selector tool at the bottom of this page to access a list of required prior authorizations under your health plan.
Prior authorizations are usually only needed in the following cases:
- Rules or contracts – Some services require approval because of rules from groups like ETF or CMS. This can vary depending on the type of service.
- Non-formulary prescriptions – Some medications need approval to make sure they are safe and work well.
- Out-of-network services – If you get care outside the Quartz network, prior authorization is often required.
- Medical policies – This includes treatments where other options should be tried first, certain health requirements must be met, or new or experimental procedures need review.
If denied, Quartz will provide an explanation and information on how to appeal. You can call Customer Success at (800) 362-3310 for assistance with the appeal process or learn more about your appeal rights here.
Contact us
Quartz Customer Success is here to answer your questions and help you through the prior authorization process. Call us at (800) 362-3310.