An Individual/Sole Proprietor is a provider that owns his/her own practice. This provider will receive payments directly from MDHHS 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. Most resources are provided in both PDF and Adobe Recording formats.
- Individual Enrollment Checklist - PDF (The intent of this resource is to provide a document that can be prefilled with the required information for completing a provider enrollment application to allow for ease of completion.)
- CHAMPS Enrollment Application: Individual/Sole Proprietor User Guide
- How to associate a billing agent and authorize the 835 - PDF
- Primary Specialty - PDF
- Quick Reference Guide - PDF
- Track Application - PDF, Recording
Domain Administrator Resources