Step 1: Determine if Provider needs to enroll

An eligible provider who complies with all licensing laws and regulations applicable to the provider's practice or business in Michigan, who is not currently excluded from participating in Medicaid by state or federal sanction, and whose services are directly reimbursable per MDHHS policy may enroll as a provider. Out-of-state providers must be licensed and/or certified by the appropriate standard-setting authority in the state they are practicing.

Providers must have their enrollment approved through the on-line MDHHS Community Health Automated Medicaid Processing System (CHAMPS) Provider Enrollment (PE) subsystem to be reimbursed for covered services rendered to eligible Medicaid beneficiaries.[1].

Providers are divided into two broad categories, Typical and Atypical.

Typical: A health care provider means a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for healthcare in the normal course of business. Medical Providers are enrolled within CHAMPS and have an NPI (e.g. Institutional (Hospital, Nursing Home, etc.,) Professional (Practitioner, Prescriber, Pharmacy, Dental, etc.)).

Atypical: The Center for Medicare and Medicaid Services (CMS) defines atypical providers as providers that do not provide health care[2]. Providers who may be enrolled in CHAMPS or Bridges and do not perform medical services (e.g. Home Help, Non-Emergency Medical Transportation (NEMT), Adult Foster Care (AFC)). Atypical providers may submit HIPAA transactions, but they do not meet the HIPAA definition of a health care provider and would not receive an NPI number.


To better help a provider determine if they need to enroll please see the below documents for the MDHHS current allowed Typical and Atypical Enrollment types. Each document is stored by Provider Type, Specialty Name, Subspecialty Name, and License/Certification.

This document is searchable: Providers can go to the Edit tab at the top and click on Find or press [Ctrl] and [F] at the same time. Type in providers, Provider Type, Specialty Name or Subspecialty, click [Enter].

Once it has been determined whether or not the provider should be enrolled continue to Step 2, Determine Enrollment Type, if the Provider needs to be enrolled.

 


[1] Michigan Medicaid Provider Manual, General Information for Providers, Section 2

[2] A health care provider is defined under HIPAA in federal regulations at 45 CFR 160.103