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. If you want 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 at –

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

Or email to: EDI@QuartzBenefits.com

Please supply an approved clearinghouse from Tab 3 on this page.

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

STEP 2

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

If you would like to know the status of your ERA enrollment or have a question regarding an ERA, call the EDI Department at (800) 362-3310.

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 Health Solutions, please have them complete, sign and mail two original copies of this trading partner agreement to this address:

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

Once both originals are received, approved and signed by Quartz Health Solutions, 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 process is complete, the 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.

STEP 1

Please complete the EFT authorized agreement form. If signing up or changing information, complete the EFT authorization in its entirty. If you want to cancel the EFT process with Quartz, complete sections 1 and 4.

Complete the Form Online
Print and Mail Form  

Return the agreement form to Quartz at:

Quartz Health Solutions, Inc.
Attn: Provider Services Dept.
840 Carolina Street
Sauk City, WI 53583

Or fax to: (608) 643-2564
Attn: Provider Services Dept.

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

STEP 2

Quartz will process enrollment. The normal enrollment time takes 7-10 business days. As part of this enrollment process, Quartz will transfer $.01 to your account as a test run. Quartz will contact your EFT provider contact to verify that the money was received. At this time, the enrollment process is complete, your next claims payment would paid via EFT.

If you would like to know the status of your EFT enrollment or have a question regarding an EFT transaction, call the Finance Department at (608) 644-3666.

STEP 3

In order to receive the tracing number to tie back to your Remittance Advice, after enrollment has been confirmed, you must contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements.

Approved Clearinghouses

Submitting Claims through a Third-Party Clearinghouse

​Quartz accepts claims electronically through third-party clearing houses.  ​Quartz uses the following EDI vendors –

  • Availity 1-800-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
  • 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 submit claims through a third-party clearinghouse, please contact one of the above clearinghouses.