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- Click ‘Get Form’ to open the edi 8291jh services online document in the editor.
- Begin by filling out Section I, ensuring all fields marked with * are completed. This includes your vendor name, mailing address, city, state, technical contact details, and marketing contact information.
- In Section II, select your request type by clicking only one option that best describes your role (Vendor, Billing Service, or Clearinghouse). If applicable, provide the name of your electronic billing software vendor.
- Proceed to Section III and check all features you support. This may include creating ANSI claim files or retrieving remittance files. Make sure to review each option carefully.
- Finally, complete the signature section at the end of the form. Print the document and sign it before sending it to Novitas Solutions via mail or fax as indicated.
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