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Page Updated On 12/07/2022

Medicare Advantage Provider Resources

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Therapy Forms

Medical Necessity Denial Letters

Benefit Denial Forms

Quartz Medicare Advantage Benefit Denial Form Instructions

Dental Services (English | Spanish)

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General Use (English | Spanish)

Gundersen Medicare Advantage (HMO) from Quartz

Elite & Value Exclusion List

Elite D, Value D, & Core D Exclusion List

Gundersen Minnesota Medicare Advantage (HMO) from Quartz

Elite & Value Exclusion List

Elite D, Value D, & Core D Exclusion List

UW Health Medicare Advantage (HMO) from Quartz 

Elite & Value Exclusion List

Elite D, Value D, & Core D Exclusion List

Benefit Plan Exclusion Lists

UW Health (SwedishAmerican) Medicare Advantage (HMO) from Quartz

Elite & Value Exclusion List

Elite D, Value D, & Core D Exclusion List

Aurora Health Care Medicare Advantage (HMO) from Quartz

Elite & Value Exclusion List

Elite D, Value D, & Core D Exclusion List

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