Get Novitasphere

Filling out the Novitasphere Enrollment Form is a crucial step for providers seeking access to the Novitasphere portal or wishing to update their existing setup. This guide offers a detailed, step-by-step process to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the Novitasphere Enrollment Form.

1. Click the ‘Get Form’ button to access the Novitasphere Enrollment Form and open it in your preferred editor.
2. Begin with Block A by selecting the appropriate contract type (Part A or Part B) and providing the state in which you are registered to bill.
3. In Block B, enter the provider's name as it appears on file with Medicare. Ensure you include the practice address details, contact person’s name, telephone number, FAX number, and email address of the contact person.
4. Also in Block B, type the Provider Transaction Access Number (PTAN), National Provider Identifier (NPI), and Tax Identification Number (TIN) or Employer Identification Number (EIN) for the provider.
5. Proceed to Block C to indicate whether you are submitting for New Enrollment or changes to an existing setup. Choose the appropriate options regarding the Novitasphere Portal Submitter ID.
6. In Block D, designate staff members who will approve End User access. Provide their first name, last name, and email address for the Provider Office Approver and, if applicable, the Back-Up Approver.
7. For Part B providers in Block E, specify your preference for Electronic Remittance Advice (ERA) by selecting from the provided options.
8. Complete Block F by providing details on who will manage electronic claims and submitting the electronic claim files to Novitas Solutions.
9. In Block G, list any additional information regarding your preference for the aggregation of remittance data, although this section is not required.
10. Finish with the signature section, ensuring the authorized official signs and dates the form. The name and title may be entered before printing.
11. After you have completed the form, submit it via fax to 1-877-439-5479 or mail it to the indicated address. Allow 5-10 business days for processing.
12. To wrap up, ensure you monitor for an approval confirmation email and follow any additional next steps provided.

Start completing the Novitasphere Enrollment Form online to ensure timely access to necessary services.