EDI 8291JH Vendor Agreement Enrolling EDI Vendors Clearinghouses or Billing services for Medicare EDI new contracts 2026

1. Click ‘Get Form’ to open the EDI 8291JH Vendor Agreement in the editor.
2. Begin by filling out Section I, ensuring all fields marked with * are completed. This includes your Sole Proprietor or Company Name, Street Address, City, State, and Technical Contact details.
3. In Section II, select your request type by clicking only one option that best describes your role (e.g., Vendor, Billing Service). Provide any additional information as required.
4. Proceed to Section III to indicate the features you support. Check all applicable boxes related to ANSI files and connection types.
5. Review the Software Terms carefully before checking the box to agree. Ensure you understand your responsibilities regarding software usage.
6. Finally, print the form, sign it in the designated area, and include the date. Mail or fax all pages of this form to Novitas Solutions using the provided contact information.

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