MDCH - Provider Enrollment

Provider Enrollment

Provider Enrollment Medicaid Payments PO Box 30238 Lansing, MI 48909	Phone (517) 335-5492
	ProviderEnrollment@michigan.gov
	Fax (517) 241-8233

Updates

October 10, 2012- Primary Specialty

April 19, 2010- Please view the notice regarding the verification of Taxonomy codes reported in CHAMPS

April 19, 2010- Office Manager Social Security Number Frequently Asked Questions Document

April 14, 2010- Letter regarding CHAMPS SED Waiver, Children's Waiver Program (CWP) Payment Implications

February 1, 2010- Instructions on how Domain Administrators can locate users within the Manage Users List Page.

October 26, 2009- Please be advised: Due to CMS Auditing regulations ( click here for CMS letter) all providers are now required to supply the office manager name and social security number within the Location step of each Provider Enrollment application. For additional information regarding this requirement, please see this notice from the Michigan State Medical Society.
(updated March 16th, 2010)

CHAMPS Provider Enrollment is Live!

Medicaid has implemented a new online Provider Enrollment system. The new system is specifically structured to comply with NPI standards. All current HIPAA-Covered* Fee-For-Service** Michigan Medicaid Providers, including Out-of-State Providers but excluding Pharmacy Providers, must access to CHAMPS to enroll in the Michigan Medicaid Program. The CHAMPS Provider Enrollment subsystem allows Providers to enroll and update data quickly and easily in addition to offering improved provider support and services.

CHAMPS online provider enrollment and maintenance replaces the paper enrollment process. New Providers can access the CHAMPS system to track the status of their application.

CHAMPS is a NPI based system and all providers, groups and/or facilities (unless otherwise exempt) must obtain and register their NPI with the National Plan and Provider Enumeration System (NPPES) prior to enrollment in CHAMPS.

NEW PROVIDERS

PE is no longer accepting any new paper applications (DCH-1625). Beginning March 31, 2008 all new providers will need to complete an enrollment through the online CHAMPS.

All new providers must have their SSN or EIN/TIN enrolled with Vendor Registration prior to enrolling within the PE subsystem. To register your SSN or EIN/TIN visit http://www.mi.gov/cpexpress.

BILLING AGENT

All new Billing Agent enrollments must also be completed utilizing the CHAMPS system. This process replaces the paper enrollment using the "Billing Agent ID Request" form. All providers who are associated to a Billing Agent will not be able complete a new enrollment until the Billing Agent has been approved in CHAMPS.

Listing of Billing Agents currently enrolled in CHAMPS

GROUP PROVIDERS

A Group provider is an organization of individual providers that provide medical or dental services. A Group provider would receive a Type 2 NPI and rendering/servicing providers would associate to the Group provider. All new Group enrollments must be completed utilizing the CHAMPS system. All providers who are associated to a Group will not be able to complete a new enrollment until the Group has been approved in CHAMPS.

FACILITY/AGENCY/ORGANIZATION (FAO)

A Facility / Agency / Organization (FAO) provider is an entity that provides health care services. A FAO includes Hospitals, Nursing Facilities, Laboratories, etc., and have a Type 2 NPI number associated to them. All new FAO enrollments must also be completed utilizing the CHAMPS system. All providers who are associated to a FAO will not be able to complete a new enrollment until the FAO has been approved in CHAMPS.

INDIVIDUAL/SOLE PROPRIETOR

Applicant Type Rendering/Servicing
Applicant Type of Rendering/Servicing is a provider who provides services through a Group, Facility, Agency, Organization or an Individual/Sole Proprietor. A Rendering/Servicing provider does not bill directly to Michigan Medicaid. The Billing Provider that is associated to this applicant type, submits claims and receives payments for the Rendering/Servicing provider. This Billing Provider must be approved in CHAMPS prior to the submission of a new enrollment application for a rendering/servicing provider.

Applicant Type Individual/Sole Proprietor
An Individual/Sole Proprietor is a provider that owns his/her own practice. This provider will receive payments directly from MDCH for services rendered at their practice. An Individual/Sole Proprietor may associate to other entities and Rendering/Servicing providers may associate to an Individual/Sole Proprietor.

CHAMPS Regional Trainings

MDCH has canvassed the State providing CHAMPS user training since April 2008. User training for other phases of CHAMPS, like Beneficiary Eligibility Verification and Claims Submission/Tracking, will be provided as they become active. For the most up-to-date training schedule and online registration please visit the Medicaid Provider Training Sessions webpage. Attendance is encouraged; all attendees must register.

Retroactive Enrollment - When requesting retro enrollment within the "Complete Enrollment Checklist" step of an application, you must indicate the date requested in the "Comment" field. If you are requesting a date prior to one year from today's date you must also include a reason for this request.

Pharmacy Providers - To enroll in the Medicaid Program as a Pharmacy Provider, contact Magellan Medicaid Administration, Incorporated for enrollment information at 888-868-9219. Pharmacy Providers can also download the enrollment form via Internet at www.michigan.fhsc.com>>Providers>>Forms. Pharmacy Providers who need to enroll as Medical Suppliers (see Medicaid Provider Manual for details) must use the CHAMPS online system.

Out of State Providers (Beyond Borderland) - MDCH reimburses out of state providers who are beyond the borderland area (defined in the MDCH Provider Manual) if the service meets one of the following criteria:Emergency services as defined by the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and the Balanced Budget Act of 1997 and its regulations; or Medicare and/or private insurance has paid a portion of the service and the provider is billing MDCH for the coinsurance and/or deductible amounts; or the service is prior authorized by MDCH. MDCH will only prior authorize non-emergency services to out of state/beyond borderland providers if the service is not available within the state of Michigan and borderland areas.

Electronic Funds Transfer (EFT)

Access the Internet and log onto the Contract & Payment Express (C&PE) Web site at http://www.mi.gov/cpexpress
Follow the C&PE steps to request a password. The password will be mailed to you via U.S. mail.
When you receive your password, access the C&PE website again and follow the steps to sign up to receive payments via EFT.
Take the Web site EFT authorization form that you completed and printed to your bank for verification and a signature. Then sign and mail the form to the address on the form.
Within two or three weeks after the form is mailed, you should start to receive payments via EFT.

If you have questions regarding this process, contact the Vendor Payee Help Desk at 1-888-734-9749.

*HIPAA/NPI-exempt Fee-For-Service Michigan Medicaid Providers such as non-emergency transportation and respite service providers will continue their current provider enrollment protocol. For details, call or email Provider Enrollment at 517-335-4952 or ProviderEnrollment@michigan.gov.

**Medicaid Health Plans will continue to maintain their own provider enrollment, prior authorization, and claims processing systems.