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
- How to associate a billing agent and authorize the 835 - PDF
- Provider Controlling Interest/Ownership Tip - PDF
- Quick Reference Guide - PDF
- Revalidation Instructions - PDF
- Track Application - PDF
Domain Administrator Resources
- Domain Administrator Functions -PDF
- Electronic Signature Agreement Cover Sheet MDHHS-5405
- Electronic Signature Agreement DCH-1401
