BadgerCare and/or Medicaid SSI Plus Appeals and Grievances
Wisconsin Medicaid Plans
Appeals
If you are still unhappy after talking to Customer Success, you have the right to file an appeal with Quartz up to 60 days after you receive an adverse benefit determination notice. You may file a request by phone or in writing:
Quartz
Attn: Appeals Specialists
2650 Novation Pkwy
Fitchburg WI, 53713
(800) 362-3309, ext 101901
AppealsSpecialists@QuartzBenefits.com
You may use the appeal filing form if submitting in writing. If filed verbally, you will still need to send a letter stating your request to appeal.
You have the right to appeal to the state of Wisconsin, Division of Hearings and Appeals (DHA), for a fair hearing if you believe your benefits were wrongly denied, limited, reduced, delayed, or stopped by Quartz. An appeal must be made no more than 90 days after the date of the decision being appealed. If you make an appeal before the effective date, the service may continue. You may need to pay for the cost of services if the hearing decision is not in your favor.
Grievances
We would like to know if you ever have concerns about our service or your claims. For help resolving your concerns, please call Quartz’s Customer Service at (800) 362-3310, or write to us if you have a grievance:
Quartz
2650 Novation Pkwy
Fitchburg WI, 53713
If you want to talk to someone outside of Quartz about the problem, call the HMO Enrollment Specialist at (800) 291-2002. The HMO Enrollment Specialist may be able to help you solve the problem. The HMO Enrollment Specialist can also help write a formal grievance to Quartz or to the BadgerCare Plus and/or Medicaid SSI Program.
You will not be treated differently from other members because you file a grievance. Your health care benefits will not be affected.
If you want a fair hearing, send a written request to:
Department of Administration
Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53707-7875
The hearing will be held with an administrative law judge in the county where you live. You have the right to be represented at the hearing or you can bring a friend for support. If you need a special arrangement for a disability or for language translation, please call (608) 266-3096 (voice) or (608) 264-9853 (hearing impaired).
You will not be treated differently from other members because you request a fair hearing. Your health care benefits will not be affected.
If you need help writing a request for a fair hearing, please call either the BadgerCare Plus and/or Medicaid SSI Ombuds at (800) 760-0001 or the HMO Enrollment Specialist at (800) 291-2002.
To file a complaint with the BadgerCare Plus and/or Medicaid SSI Program, send your concern to:
BadgerCare Plus and/or Medicaid SSI
Managed Care Ombuds
P.O. Box 6470
Madison, WI 53716-0470
(800) 760-0001
If your complaint or grievance needs action right away because a delay in treatment would greatly increase the risk to your health, please call Quartz as soon as possible at (800) 362-3310.
You will not be treated differently from other members because you file a grievance. Your health care benefits will not be affected.