Get Novitas Solutions 8292p 2018-2025

The Novitas Solutions 8292P form is essential for enrollment and access to the Novitasphere Portal. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Novitas Solutions 8292P online effectively.

1. Press the ‘Get Form’ button to access the Novitas Solutions 8292P form and open it in your preferred editing software.
2. Begin filling out the required fields marked with an asterisk (*). Start with Part A, where you will check all applicable institutional or professional agreements.
3. Complete the Provider Information section. Ensure that the provider name matches what was reported on the CMS-855 Enrollment form, and fill in the street address, city, zip code, state, contact name, telephone number, fax number, and email address.
4. Enter your Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI). If you have affiliated PTANs or NPIs, attach them on company letterhead.
5. Provide your Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN). If you choose the environmentally friendly option, indicate that you prefer to receive information only via email.
6. For the Request Type, select either New Enrollment or Change Enrollment and provide the reason for submission. If adding to an existing Novitasphere Portal submitter ID, include the submitter ID name.
7. Assign roles for the Novitasphere Portal Security section. Name the Provider Office Approver and Back-Up Approver, which will be used for registration within the Enterprise Identity Management system.
8. Designate your Electronic Remittance Advice (ERA) by selecting from the options provided. Your selection will determine whether you maintain your existing setup or assign ERA to a new submitter ID.
9. If applicable, indicate if you want to maintain existing submitter/receiver IDs in the next section.
10. Provide Additional Information and Referral Information if desired. This section is optional but can be used to share your preferences for remittance data aggregation.
11. Once all sections are complete, review the form for accuracy, print it out, and add your written signature, date, printed name, and title.
12. Mail or fax all pages to Novitas Solutions, Inc. as specified.

Complete your Novitas Solutions 8292P form online today for efficient enrollment and access.