Quartz offers our providers helpful prior authorization resources on our Quartz Prior Authorization Resources page. You can find prior authorization lists, forms, criteria, and other prior authorization information here. Please keep in mind:
- Effective immediately, outpatient high-tech radiology services will no longer require prior authorization. This includes cardiac nuclear stress tests, CT and CTA, MRI and MRA, and PET scan.
- Hysteroscopies will require prior authorization.
- Effective March 1, 2024, many services will be removed from the prior authorization list for commercial lines of business:
- Ambulatory ECG – External and Implantable
- Blepharoplasty, Levator Repair, Brow Ptosis Procedures
- Breast Reduction Mammoplasty
- Breast Reconstruction Post Mastectomy
- Bone Anchored Hearing Aids (BAHA)
- Continuous Glucose Monitoring Device (CGM) and Supplies
- Cranial Helmet
- Endoscopic Procedures and Non-Endoscopic Devices for Treatment of Gastroesophageal Reflux Disease (GERD) – LINX® Reflux Management System
- Endoscopic Myotomy Procedures for Treatment of Esophageal Achalasia and Gastroparesis – Per-Oral Endoscopic Myotomy (POEM) & Per-Oral Pyloromyotomy (POP) Procedures
- High Tech Radiology
- Hospital Beds & Supplies
- Insulin Pump & Supplies
- Left Atrial Appendage Closure – Watchman Procedure
- Negative Pressure Wound Therapy (Wound Vac)
- Photodynamic Therapy
- Prolotherapy
- Prosthetic Eye
- Radioembolization Y-90 (TheraSpheres/SIR Spheres) Procedure
- Sacral Nerve Stimulation
- Septoplasty
- Transcatheter Closure of Septal Defect Procedure
- Vagus Nerve and Deep Brain Stimulation Procedures
- Walking Aids
- Wearable Cardioverter/Defibrillator
It is the providers responsibility to determine if a prior authorization is required, not the members. Prior authorization requests should be submitted through the appropriate provider portal. Utilizing that process may result in immediate decisions. However, it is critical to remember that it can take up to 15 days for approval. Please allow appropriate review time prior to scheduled procedures for a decision to be made. Retro authorization requests will not be accepted.
Find all prior authorization resources here.
