Provider Prior Authorization Resources:
General List
General List
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.
Here are some guidelines to consider for prior authorization submission:
- In-network providers are encouraged to utilize My Quartz Tools for prior authorization submission.
- Out-of-network providers IN the Quartz service area can utilize the Quartz Prior Authorization Request Form.
- Out-of-network providers OUT of the Quartz service area should contact Quartz Customer Success (800) 897-1923. If Quartz is the secondary payor, fill out the Quartz Prior Authorization Request form.
Please note, different prior authorization rules and criteria may apply if services are received outside the Quartz service area. If the above scenarios do not pertain to you or you have additional questions, please contact Quartz Customer Success at (800) 897-1923.
- 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 clinic-administered medications. Practitioners must submit a prior authorization request via My Quartz Tools or fax a Medication Coverage Request Form to Quartz at (608) 471-4389.
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 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)
- 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