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Southwest Health

Prior Authorization List

Contact Quartz Customer Service with specific code information to determine if an item or service requires prior authorization.

The following Prior Authorization List is not an all-inclusive list and will be updated on a periodic basis. Providers are encouraged to review the Prior Authorization List frequently for changes. Prior authorization is not a guarantee of payment.

Behavioral Health Services 

Durable Medical Equipment

Any purchase items in excess of $500 in billed charges, and all equipment rental, require prior authorization.

Inpatient Admissions

Note: Urgent/emergent hospital admissions require notification at the time of admission. Elective hospital admissions require prior authorization before admission and notification when admitted.

Other Services

Out-of-Network Services or Supplies

Medication

Prior authorization is required for clinic-administered medications. Practitioners must submit a prior authorization request via My Quartz Tools or fax a Medication Prior Authorization Request Form to Quartz at (888) 450-4711.

Surgical Procedures

Note: The following procedures must be prior authorized before they are scheduled.

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