Quartz Provider Forms

Because you said "Yes" to engaging in offshore¹ services that involves the receipt, processing, transferring, handling, storing, or accessing Quartz Medicare Advantage member Protected Health Information (PHI), you are required to:

• Complete a Quartz Medicare Advantage Offshore Services Attestation ("Attestation") for EACH offshore entity, or • Upload documentation that supports ALL of your offshore entities. • Note: Only report offshore entities that you use to perform a Quartz contractually delegated service that requires the receipt, processing, transferring, handling, storing or accessing of Quartz member protected health information (PHI).

Both options will appear upon submission of your completed Medicare Advantage FDR Annual Compliance Attestation. IMPORTANT NOTE: Please ensure your documentation equals the number of offshore entities you indicated on your Quartz Medicare Advantage FDR Annual Compliance Attestation. If you don't, you will receive weekly email reminders until ALL documentation has been received.

¹The term 'offshore' refers to any country that is not within one of the fifty United States or one of the United States Territories (American Samoa, Guam, Northern Marianas, Puerto Rico, and Virgin Islands). Examples of countries that meet the definition of “offshore” include Mexico, Canada, India, and Philippines. Subcontractors that are considered offshore can be either American-owned companies with certain portions of their operations performed outside the United States or foreign-owned companies with their operations performed outside the United States. Offshore subcontractors are doing work that provides support for or directly performs delegated services that are located in offshore countries, regardless of whether the workers are employees of American or foreign companies.

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