Medicare Advantage provider resources

Clinical Practice Guidelines & Case Management

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Evidence-based clinical practice guidelines

Quartz monitors practitioner utilization of evidence-based clinical practice guidelines through the analysis of the publicly reported HEDIS® rates. The goal is to help ensure that clinical guidelines are current, evidence-based, and meet the needs of our population.

Clinical practice guidelines

The below clinical practice guidelines are resources for participating providers and are not a substitute for a provider’s clinical judgment or recommended plan of care. Coverage of services mentioned in the guidelines may differ depending on the individual’s health plan and does not imply or guarantee coverage. We encourage you to review the patient’s coverage to determine benefits. To confirm coverage, please contact Quartz Customer Success at (608) 881-8271 or (800) 897-1923.

View the clinical practice guidelines and resources adopted by Quartz below.

American Heart AssociationHeart disease
American Diabetes AssociationDiabetes
American Psychiatric AssociationBehavioral health
US Preventive Services Task ForcePreventive care
National Heart, Lung, and Blood InstituteHeart, lung, blood, sleep disorders
National Institute of HealthClinical resource
American College of PhysiciansClinical resource
A senior woman consulting with her doctor about a medication

Complex Case Management

What is 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.

A doctor talking to an older woman with records on her laptop

Diabetes Disease Management

We provide our members with education and support. Helpful information is sent by mail. We are also available by phone. This program is voluntary, and your patients can call at any time to opt-out.

If you would like to enroll a patient, in a disease management program, call the Disease Management Coordinator at (886) 884-4601.

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