Get Jh Novitas Solutions Edi Fax Cover Sheet Please Use When Faxing Any Type Of Written Requests To

The JH Novitas Solutions EDI Fax Cover Sheet is an essential document for submitting written requests via fax. This guide will walk you through the process of filling out this cover sheet with detailed, step-by-step instructions to ensure a smooth submission.

Follow the steps to complete the fax cover sheet accurately.

1. Click the ‘Get Form’ button to download the JH Novitas Solutions EDI Fax Cover Sheet and open it for editing.
2. In the 'To' field, enter 'Novitas Solutions EDI Services' to specify the recipient of your fax.
3. Fill in your name in the 'From' field, indicating the sender of the documents.
4. Provide the name of your organization in the 'Company' field to identify the source of the fax.
5. Input the fax number in the 'Fax Number' field, ensuring it is accurate for direct transmission.
6. Enter the current date in the 'Date' field, which helps in tracking the submission.
7. Add your phone number in the 'Phone Number' field for any follow-up communication regarding the faxed documents.
8. Specify the total number of pages being sent, including the cover sheet, in the 'Total Number of Pages Including Cover' section.
9. Include your National Provider Identifier (NPI) number in the 'NPI #' field for proper identification.
10. Enter your Provider Transaction Access Number (PTAN) in the corresponding field to link your documents accurately.
11. If applicable, indicate any reference number assigned by an EDI representative in the 'Reference Number' field.
12. Summarize the subject of your fax in the 'RE' field, providing context for the recipient.
13. Review all filled information for accuracy and completeness.
14. Once confirmed, save the changes to the document, then proceed to print or send the fax as required.

Complete your JH Novitas Solutions EDI Fax Cover Sheet online to ensure timely and accurate fax submissions.