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Authorization Agreement for 835

Thank you for your interest in the Electronic Health Care Claim Payment/Advice (835), also known as Electronic Remittance Advice (ERA). Once this process begins, ERAs will be securely delivered to your designated trading partner data repository. This will include a tracing number that will tie back to your EFT (Electronic Funds Transfer) or check payment.

STEP 1

Please complete the ERA Authorized Agreement Form. If signing up or changing information, fill out the form completely. To cancel the ERA process with Quartz, complete sections 1, 2, and 7.

Complete the Form Online 
Print and Mail Form

Return the ERA Authorized Agreement Form to:

Quartz
Attn: EDI Dept.
840 Carolina Street
Sauk City, WI 53583

Or email to:

EDI@QuartzBenefits.com

Attn: EDI Dept.

Quartz sends 835 Remits electronically through third-party clearinghouses. Please supply an approved 835 clearinghouse used by Quartz:

Availity (800)-AVAILITY or (800) 282-4548

  • Netwerkes (800) 765-6713
  • Change Healthcare (Formerly Emdeon, excludes ERA) (877) 469-3263
  • PayerPath (877) 347-6691
  • SSI Group (800) 880-3032
  • G and C Clearing House (888) 456-9707
  • Healthcare Data Systems (800) 486-2273 (Excludes ERA)
  • CPSI (251) 662-4078
  • TriZetto Provider Solutions (Formerly ClaimLogic) (405) 942-9800
  • Viatrack (800) 426-3385
  • Health Claims Services (608) 831-1563
  • Outsource Inc (262) 544-4442

If you are a provider and would like to receive your 835 Remits electronically, please contact one of the above clearinghouses.

If you have any questions on this form, please contact your Quartz Provider Coordinators.

STEP 2

Quartz will process your ERA Authorization Agreement within seven business days. At the time the process is complete, your next claims payment advice will be an ERA.

If you would like to know your ERA enrollment status or have a question regarding an ERA, email EDI@QuartzBenefits.com.

STEP 3

In order to receive your ERA after your authorization agreement has been confirmed, you must contact your vendor or clearinghouse to arrange for the delivery of the CORE-compliant ERA.

NOTE: If your vendor or clearinghouse does not have an existing trading partner connection with Quartz, please have them complete, sign, and mail two original copies of this Electronic Trading Partner Agreement to this address:

Quartz
Attn: EDI Dept.
840 Carolina Street
Sauk City, WI 53583

Once both originals are received, approved, and signed by Quartz, one of the originals will be mailed to the vendor or clearinghouse. Then, Quartz will complete one successful round of testing with this vendor or clearinghouse using the ERA claim tests for the provider seeking authorization. When this testing is complete, the enrollment process is confirmed.

EFT Authorization

Thank you for your interest in Electronic Funds Transfer (EFT) for your claim payments. Once this process begins, claims payment will be electronically deposited into your checking account weekly. This will include a tracing number that will tie back to your remittance advice. 

To request the EFT-authorized agreement form, please contact Customer Service at (800) 362-3310 or your designated Provider Coordinator.

If you have submitted the EFT authorized agreement form and would like to know the status of your EFT enrollment or have questions regarding an EFT transaction, call the Finance Department at (608) 644-3666.

Approved Clearinghouse

Submitting Claims through a Third-Party Clearinghouse

Availity Transition Effective 3/1/2021

​Quartz accepts claims electronically through a third-party clearinghouse, Availity.

Availity: 1-800-AVAILITY or (800) 282-4548

If you are a provider and would like to submit claims through a third-party clearinghouse, please contact Availity at the number listed above.