Prior Authorization (PA)
Medical Necessity Denial Letters
Benefit Denial Forms
Benefit Plan Exclusion Lists
Gundersen Senior Preferred
ProHealth Senior Preferred
UW Health Senior Preferred
Online Provider Forms
Electronic Data Interchange Forms
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)
Join Our Network
Fill out the the Provider Participation Request Form; then,
- Email to
- or fax to (608) 643-2564
Fulcrum Health, Inc., contracts for chiropractors on behalf of Quartz Senior Preferred.
- Contact Fulcrum at firstname.lastname@example.org or (763) 204-8570 for network participation
- For more information visit the Fulcrum Health website
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
Please log in here for updates required by Quartz / Senior Preferred for the annual Facility Operations Form and CMS quarterly verification updates.
You can reach a provider representative at:
- Phone: (608) 881-8234 or (608) 370-8711
- Fax: (608) 881-8393
Communications, Manuals and Standards
Health Tools and Programs
This web page was updated on September 12, 2019.