Novitas Solutions Inc. administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) for Jurisdiction H which includes the State of New Mexico. If you are a provider located in New Mexico and need to become an electronic submitter for your Medicare A/B Claims, please follow the enrollment instructions below.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Novitas Solutions office prior to initiation of electronic claims submission or inquiry.
 

To access these forms, please Go Here: www.novitas-solutions.com/webcenter/portal/MedicareJH?

Select your Jurisdiction. Then choose "Forms" on the left-hand side. Select the appropriate form under the subtitle "Electronic Data Interchange (EDI) Enrollment Forms".

1. Novitas Solutions EDI Enrollment Form (8292)
2. Novitas Solutions Vendor Agreement Form (8291) (For Billing Services Only)
 

If you have any questions regarding any of the documents in this package, please call the Novitas Solutions EDI Technology Support Center at 1-855-252-8782.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Electronic Data Interchange (EDI) Enrollment Form

Section A:

• Select your Line of Business and State

Section B:

• Enter the name of the Group, Provider, Or Supplier who is applying for a Submitter ID
• Enter your Practice’s demographic information
• Enter your contact information, including email address
• Please enter the Provider’s PTAN, NPI and TIN or EIN
  • Please note, if you are in a group practice with rendering providers, only the group practice's information should be entered

Section C: 

• Select the box for New Enrollment. Place a check next to Assign this provider a new electronic billing submitter ID
  • For name of software vendor, enter the name of the software vendor you will be using to create your claims. If you will be using SolAce, please call us for our information

Section D:

• Check the box to "Assign ERA to the new Submitter ID being requested in block C of this form"

Section E:

• Skip this section

Section F: 

• If you need to enroll for PC Ace check both boxes. If you do not, skip this section

Section G:

• Select either your NPI or your TIN

Signature Section:

• Type your Name and Title, then Sign and Date

EDI Third Party Enrollment Form (Billing Services Only)

Section I.

• Enter your Company’s Name, Demographic info, and Contact information
• Skip the first box referencing being included on the approved vendors list
• Check the second box if you do not wish to receive paper mail responses

Section II.

• Check the box that says "I am a Billing Service that will be submitting claims directly to Medicare”
  • Name of Vendor: Enter the name of the vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our SolAce billing software, please call us for our Vendor information

• Check the box to assign a new ERA Receiver ID only for Billing Service if you will be receiving your Provider's ERAs

Section III.

Check these boxes:

• Create ANSI ASC X12N 837 version 5010 claim files

• Retrieve ANSI ASC X12N 835 version 5010 remittance files

• Provide services to the following contracts: Check applicable boxes for Part A, and/or Part B

Section IV. Skip this section

Signature Section: Print your Name and Title, then Sign and Date this application

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Send the enrollment forms reflecting original signatures to:

Novitas Solutions, Inc. EDI Department

Fax: 1 (877) 439-5479

or

Mail: P.O. Box 3011, Mechanicsburg, PA 17055-1801

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be mailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Novitas Solutions EDI Technology Support Center at 1-855-252-8782.

Testing

Once you have received your Submitter ID and Password from Novitas Solutions, please call the ClaimShuttle Support Team at 602-439-2525 and set an appointment for a Mailbox setup and Test Transmission to Novitas Solutions.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.