Providers can sign up, change or cancel the electronic data interchange (ERA) agreement with Quartz by submitting this form.

The Quartz D-SNP training is required annually for in-network and out-of-network providers who routinely see Quartz Medicare Advantage Dual Eligible w/Rx members. Practitioners who only see Quartz commercial members are excluded from this training.

FDRs are individuals or entities that provide administrative or health care service functions relating to the Medicare Advantage contract with CMS, and are required to complete an annual compliance attestation.

Use this form for new facilities, updates to existing facilites or facilities that are terming.

Use this form for new practitioners, updates to existing providers or providers that are terming.

Use this form for interest in joining the network.