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

Download the appropriate EDI Enrollment form (JL or JH):

• Novitas JL Enrollment Form (PDF)
• Novitas JH Enrollment Form (PDF)

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.*

After completing the form:

1. Print and sign the document.
2. Send it to Novitas by either:
   • Fax: 1 (877) 439-5479
   • Mail:
     1. JL: Novitas Solutions, Inc. - EDI - PO Box 3011, Mechanicsburg, PA 17055-1801
     2. JH: Novitas Solutions, Inc. - EDI - PO Box 3093, Mechanicsburg, PA 17055-1811

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)

• 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:
  • Novitasphere JL
  • Novitasphere JH