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.


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 Provider Relations Coordinator.


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.


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.