Medicare Advantage provider resources
Clinical Practice Guidelines & Case Management
Evidence-based clinical practice guidelines
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.
| Organization | Category |
|---|---|
| American Heart Association | Heart disease |
| American Diabetes Association | Diabetes |
| American Psychiatric Association | Behavioral health |
| US Preventive Services Task Force | Preventive care |
| National Heart, Lung, and Blood Institute | Heart, lung, blood, sleep disorders |
| National Institute of Health | Clinical resource |
| American College of Physicians | Clinical resource |
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.
