====== Novitas Enrollment Instructions ======

Novitas enrollment requires completion of a PDF form. The process is straightforward:

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===== Step 1: Download the Enrollment Form =====
Download the appropriate EDI Enrollment form (JL or JH):  


  *  {{ :novitas_jl.pdf | Novitas JL Enrollment Form (PDF)}}
  * {{ :novitas_jh_1_.pdf |Novitas JH Enrollment Form (PDF) Professional}}

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===== Step 2: Complete the Form =====
Fill out the form with the required information:
  * Provider Name, Contact Information, and Address  
  * PTAN, NPI, and Tax ID  
  * Request Type (New or Existing Submitter ID)  
  * ERA selection (if applicable)  

*Make sure all required fields marked with an asterisk (*) are completed.*

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===== Step 3: Print, Sign, and Submit =====
After completing the form:
  - **Print and sign** the document.  
  - Send it to Novitas by either:  
    * **Fax**: 1 (877) 439-5479  
    * **Mail**:  
      - JL: Novitas Solutions, Inc. - EDI - PO Box 3011, Mechanicsburg, PA 17055-1801  
      - JH: Novitas Solutions, Inc. - EDI - PO Box 3093, Mechanicsburg, PA 17055-1811  

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===== Step 4: Confirmation =====
Allow up to **10 business days** for processing.  
Do not send duplicate forms.  

For questions, contact an EDI Analyst:  
  * JL: 1-877-235-8073 (Option 3)  
  * JH: 1-855-252-8782 (Option 3)  

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===== Notes =====
  * Paper remittance continues briefly after ERA enrollment (31 days for Part A, 45 days for Part B).  
  * New submitters must connect to Novitas within 90 days of receiving their logon ID.  
  * You may also consider enrolling in **Novitasphere**, the free secure portal for electronic transactions:  
    * [[http://www.novitas-solutions.com/webcenter/portal/Novitasphere_JL|Novitasphere JL]]  
    * [[https://www.novitas-solutions.com/webcenter/portal/Novitasphere_JH|Novitasphere JH]]