Provider Prior Authorization Resources:
Illinois
Illinois
Different prior authorization rules and criteria may apply if services are sought outside the Quartz service area.
Contact Quartz Customer Success at (800) 897-1923 to see if it applies to your situation.
Contact Quartz Customer Success at (800) 897-1923 to see if it applies to your situation.
The services listed below require prior authorization. Prior authorization is not a guarantee of payment. Quartz will provide advance notice of changes to prior authorization requirements and will not apply a change in coverage or approval criteria for a previously authorized service sooner than the end of the plan year.
- Experimental and Investigational Treatments
- In-home Therapy
- Partial Hospital Program (PHP)
- Residential Treatment
- Transcranial Magnetic Stimulation (TMS)
- Vagus Nerve Stimulation
See your Schedule of Benefits for prior authorization requirements on DME items.
- Elective hospital admissions require prior authorization before admission and notification when admitted
- Hospice/Palliative Care
- Hospitals, Acute Inpatient Care
- Inpatient Rehabilitation Facilities
- Long-Term Acute Care Hospital (LTACH)
- Psychiatric Admissions
- Skilled Nursing Facility/Swing Bed
Practitioners must submit a prior authorization request via My Quartz Tools or fax a Medication Coverage Request Form to Quartz at (888) 450-4711.
We encourage you to submit your prior authorization requests via Optum’s ePA tool. We’re here to help and you can call Quartz Customer Success at (888) 450-4711 if you have any questions.
- Bariatric Surgery
- Blepharoplasty
- Bone Anchored Hearing Aids (BAHA)
- Breast Surgery
- Brow Lifts
- Cochlear Implants
- Deep Brain Stimulation
- Endoscopic procedures for Reflux Management (LINX)
- Gender Affirming Surgery
- Implantable Nerve Stimulators
- Laser resurfacing for non-cosmetic procedures (cosmetic procedures are excluded)
- Laser Treatment of Actinic Keratosis or other benign skin lesions
- Left Ventricular Assist Devices (LVAD) for the Treatment of Heart Failure
- Orthognathic Procedures
- Orthopedic Procedures (including Artificial Cervical and Lumbar Disc Surgery, OATS Procedures)
- Panniculectomy
- POP (Per-Oral Pyloromyotomy) Procedure
- Removal of Port Wine stains and Hemangiomas
- Rhinoplasty and Septorhinoplasty
- Robotic Assisted Procedures
- 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)
- Varicose Vein Procedures (including Sclerotherapy, Radiofrequency Ablation, Vein Stripping, and Ligation)
If your patient is out of network, prior authorization is needed for non-emergency care received. Contact Customer Success at (800) 897-1923 for help.
- Ambulance Services (non-emergent/urgent)
- Biofeedback (coverage limited to the treatment of Spastic Torticollis, headache, or Pediatric Urinary Incontinence)
- CAR T-Cell Therapy
- Custom Shoes and Custom-molded Orthotics (including orthopedic shoes)
- Experimental and Investigational Treatments
- Extracorporeal Shockwave Therapy
- Genetic Testing
- Home Health Care (including Home Infusion Services and Other In-Home Therapy Services)
- Hyperbaric Oxygen Therapy
- Infertility Treatment
- Private Duty Nursing
- Prolotherapy
- Proton Beam Therapy
- Radioembolization with Yttrium 90 Microspheres (TheraSphere™/SIR-Spheres®) Treatment
- Treatment of Urinary and Fecal Incontinence
- Vagus Nerve Stimulation
- Wound Therapy-Advanced, including Negative Pressure/Vac Therapy and Bioengineered Skin Substitutes