Medicare Advantage Provider Resources
Clinical Practice Guidelines & Case Management
Evidence-based Clinical Practice Guidelines
Clinical Practice Guidelines
Clinical practice guidelines assist in the delivery of care by providing a baseline of best practices, defined by the best evidence in the scientific literature. There are thousands of different guidelines, many for the same conditions; however, each guideline is influenced by the perspective of the person using them and the system of care in which the care is provided.
Coverage of services mentioned in the guidelines may differ depending on the individual’s particular health plan. Please contact Quartz Customer Success to confirm coverage by calling (608) 881-8271 or (800) 897-1923.
Complex Case Management
How does Complex Case Management work?
Our Complex Case Managers are registered nurses and/or social workers. The case manager works closely with you and your patient to guide them through medical and community resources to ensure they get the best care possible. Case management staff work directly with your patients to set personal goals and create a plan to improve their quality of life. The program is free for health plan members and does not affect their coverage.
Who might benefit?
Patients who have multiple serious health problems such as diabetes, heart failure, COPD, and/or behavioral health concerns.
Patients who have had several emergency room visits or hospital stays in a short period of time
Who to Contact
Call (844) 403-1712
Benefits are subject to health plan terms.
