Unity Pharmacy Forms

Electronic Health Care Claim Payment / Advice (835)

Authorization Agreement For Electronic Health Care Claim Payment /
Advice (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.


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 the EDI ​web page.

If you have any questions on this form, please contact your 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 800.362.33​10.


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.