TRAINING SESSION REGISTRATION 

Please choose one CHAMPS session below that you would like to attend.

Contact Information 

Primary Contact: 

*Email Address: *

EMAIL ADDRESS IS MANDATORY .  MDCH will not receive your registration if the "Email Address" field is blank.  If you do not have an email, please enter ProviderOutreach@michigan.gov.

*First Name: *Last Name:  

*Phone Number: 

Provider Information 

Provider Name: 

*NPI:      

*Billing Agent/Clearing House Contact Info:  
(E-mail preferred) 

Claim Example(s) for afternoon break out session: