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Electronic Data Interchange Enrollment Forms

Important Enrollment Information

Please allow 10 business days before contacting Electronic Data Interchange (EDI) Services for a status of electronic billing forms sent for processing.
Avoid submitting a duplicate request, and inquire about the status of your submitted form by using the Form Status and Verification Inquiry Tool.
Effective March 2, 2018, EDI Services will return all enrollment forms received that contain a form revision date older than R11-17.
Avoid having your form returned for corrections! Novitas Solutions EDI requires that the Authorized Official or Delegated Official as listed on the CMS-855 sign the EDI enrollment form (8292JH), and other EDI provider forms.

Novitasphere Portal

Get instant access to the world of online Medicare transactions with Novitasphere!

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Novitasphere is a FREE, secure internet portal for Part A and B customers to use to easily connect directly to Novitas Solutions. Novitasphere provides quick access to beneficiary eligibility, claim submission, claim corrections (Part B), electronic remittance advice, and many other time saving features. To learn more and enroll for Novitasphere, visit the Novitasphere Center.

EDI Enrollment Forms

To connect to Novitas Solutions via Secure File Transfer Protocol (SFTP) directly or by billing service or clearinghouse, please review the EDI Enrollment forms below.

Prior to enrolling for electronic billing, please carefully review the Technical Requirements for electronic billing and the General Tips for Completing EDI Enrollment Forms.

This form should be completed by providers using SFTP or a billing service/clearinghouse to submit claims and/or retrieve reports.
This form should be completed by Part A providers requesting access to the Fiscal Intermediary Shared System (FISS).
This form should only be completed by a vendor, billing service, or clearinghouse.
Providers who use an in-house software and will be requesting multiple submitter IDs, please complete this form to have your software added to our database.
Complete this form to update information we have on file to mail you EDI-related documents.

Top 8292JH Form Return Reasons - Updated February 2019

Reason for Return

How to Avoid A Return

Invalid signature/printed name. The Authorized Official or Delegated Official as listed on the CMS-855 is required to sign.

This continues to be the number one reason forms are returned for corrections.

The Authorized Official or Delegated Official as listed on the CMS-855 is required to sign. If you are unsure who your authorized or delegated official(s) on file are, this information can be verified in the Provider Enrollment Chain and Ownership System (PECOS).

Missing/Incorrect name of provider, group or supplier

Ensure the provider name on the EDI forms matches the provider name that Novitas Solutions has on file. This is the name used when completing the CMS-855 form and enrolling with the Medicare program.

Missing/Incorrect PTAN

Your PTAN is assigned to you by Provider Enrollment upon completion of the CMS-855 form. Ensure the PTAN is reported in the required field. The PTAN is the same as your Provider Identification Number (PIN) that you used for billing prior to being required to report a National Provider Identifier (NPI). You may also know this as your legacy identifier or Medicare provider number.

Missing/Incorrect NPI

The NPI is a unique identification number for covered health care providers. The NPI is a 10-digit number. Ensure that the NPI is reported in the required field in addition to your PTAN, and that it is correct.

The Maintain Existing Submitter/Receiver ID Setup block was incomplete

Review the Maintain Existing Submitter/Receiver ID Setup block and indicate if there are any submitter/receiver IDs you wish to maintain. This is a required block for existing EDI customers, and will be noted as incomplete if the form is being returned for other corrections.

Hypertext Transfer Protocol Secure (HTTPS) Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules (CORE)-Compliant Connection for EDI

Click here for information on the HTTPS CAQH CORE-Compliant Connection for EDI.

If you need assistance, please contact an EDI Analyst.

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Last modified:  02/26/2019