To request a prior authorization or for questions about benefits, eligibility or claims status, contact Customer Service at (800) 394-5566 or TTY  711.

To submit a request to join our network, complete the Provider Participation Request Form and send it to

Benefit Plan Exclusion Lists

Gundersen Senior Preferred

Elite & Value Exclusion List

ProHealth Senior Preferred

Elite Exclusion List

UW Health Senior Preferred

Elite Exclusion List

Value Exclusion List

Other Forms

Provider Participation Request Form

Non-Contracted Provider Notification of Appeal Process

Non-Contracted Provider Waiver of Liability

Claim Reopening Request Form

Claim Adjustment Form

Coding Denial Appeal Form
(used when there is a request for review of coding-related denial with an explanation of why provider feels it is coded correctly or when there is a request of Appeal of Coding denial with explanation & supporting documentation. A claim should not accompany this form)


2020 Provider Directory
2020 Formulary and Criteria

Join Our Network

Fill out the Provider Participation Request Form; then,

Chiropractic Providers

Fulcrum Health, Inc., contracts for chiropractors on behalf of Quartz Senior Preferred.

Durable Medical Equipment, Home Health and Infusion Therapy Providers

  • Contact Chartwell at (608) 831-8555 or (800) 730-8555 for your DME, home health or infusion therapy needs.

Claims Submission Address -

Senior Preferred Claims
PO Box 211221
Eagan, MN 55121

Electronic Payor ID# 66705

Provider Portal

Please log in here to access My Quartz Tools, our Provider Portal. 

You can reach a provider representative at:

This web page was updated on March 13, 2020.