Group

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.

• CHAMPS Enrollment Application: Group User Guide
• Quick Reference Guide - PDF 
• ​​Track Application - PDF
• Provider Controlling Interest/Ownership Tip - PDF 
• Revalidation Instructions - PDF 

 

• Domain Administrator Functions -PDF
  • Quick Reference Guide
  • Manage User List Page for Domain Administrators 
• Electronic Signature Agreement Cover Sheet MDHHS-5405
• Electronic Signature Agreement DCH-1401

 

 

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