Page Updated On 09/08/2021

Medicare Advantage Provider Resources

Clinical Practice Guidelines & Case Management

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.

Clinical 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.

Coverage of services mentioned in the guidelines may differ depending on the individual’s particular health plan. Please contact Quartz Medicare Advantage Customer Service to confirm coverage by calling (800) 394-5566.

Diagnosis and Management of Asthma

Standards of Medical Care in Diabetes

Preventive Health Guidelines

Case & Disease Management

What Is Complex Case Management?

Complex Case Management is the coordination of care, services, and resources for members who have complex medical and social needs.

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 (866) 884-4601.

Benefits are subject to health plan terms.

Diabetes Disease Management

The Diabetes Disease Management Program is offered to members with diabetes. 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.

Welcome. We're Happy You're Here!

Thank you for choosing Quartz Medicare Advantage. We are honored that you have entrusted us with your health insurance needs, and we are committed to making your experience be the best it can be.