Quartz Prior Authorization Lookup
Latest Quartz prior authorization updates8
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Part B Step Therapy Program Prior Authorization CriteriaDefines step therapy prior authorization requirements for selected Part B drugs (medical benefit) and biosimilars for Quartz members; applies to providers requesting coverage for the listed HCPCS/J-codes and brand/generic products under the insurer's Part B program.All quartz updates
- Prior AuthClinical/Medical PolicyEff. 2025-02-26Rituximab Intravenous Products Clinical ResourceGoverns Quartz coverage, clinical guidance, dosing, and prior authorization requirements for rituximab intravenous products (brand and biosimilars) across approved indications for affected members and providers.All quartz updates
- Prior AuthClinical/Medical PolicyEff. 2023-02-01Filgrastim Products (Neupogen, biosimilars, tbo‑filgrastim) — Coverage CriteriaGuidance on clinical use and prior authorization requirements for filgrastim products (Neupogen and biosimilars, plus tbo-filgrastim) for members of Quartz Health Benefit Plans; specifies indications, dosing durations, and when prior authorization is required.All quartz updates
- Prior AuthClinical/Medical PolicyEff. 2022-09-01Bevacizumab Products Clinical Resource (coverage criteria)Defines Quartz's coverage stance, clinical considerations, and prior authorization requirements for bevacizumab (brand and biosimilars) across oncologic and ophthalmic indications for members covered by Quartz plans.All quartz updates
- Prior AuthClinical/Medical PolicyEff. 2022-09-01Hyaluronic Acid Derivatives — Clinical Coverage Guidance for Knee OsteoarthritisClinical coverage guidance for intraarticular hyaluronic acid derivative products used to treat knee osteoarthritis for Quartz members; indicates which products require prior authorization and sets medical necessity criteria and dosing. Affects ordering/administration by physicians in rheumatology, orthopedics, and physical medicine/rehabilitation.All quartz updates
- Prior AuthClinical/Medical PolicyMedicare Part B outpatient medication coverage and step therapyGoverns coverage and prior authorization / step therapy expectations for outpatient medications billed under Medicare Part B for Quartz Medicare Advantage members; applies to providers who administer clinic-based Part B drugs and to PA processes used by the plan.All quartz updates
- Prior AuthClinical/Medical PolicyPart D medication step-therapy criteriaDefines step-therapy requirements for specific Part D-covered medications for Quartz Medicare Advantage and Dual Eligible members; affects prescribers and pharmacists managing prior authorization/step edits.All quartz updates
- Prior AuthAdministrative/Operational PolicyQualified health plan transparency of coverageGoverns Quartz's consumer-facing explanations of coverage operations and member responsibilities for qualified health plans, including claims handling, prior authorization, drug exceptions, out-of-network billing, grace periods, and coordination of benefits. Affects Quartz members, providers submitting claims, and authorized representatives.All quartz updates
Tool Description
Search Quartzprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior Authorization by Payer
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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