Step 2: Determine CHAMPS Enrollment Type

MDHHS requires that NPI numbers be reported in any applicable provider loop or field (e.g., billing, rendering, referring, ordering, prescribing) on the claim. A provider's Taxpayer Identification Number (TIN) will also be used for claim adjudication. The TIN reported is either the provider's Employer Identification Number (EIN) or Social Security Number (SSN). 

Definitions of Type 1 and Type 2 NPI’s:

  • A Type 1 (Individual) NPI is the number associated with an individual healthcare professional (e.g., MD, DDS, CRNA, etc.). The individual may be a sole proprietor or be employed by a clinic, group practice, or other organization. If a sole proprietor, the Type 1 NPI must be reported in the billing provider loop or field of the claim for payment.
  • A Type 2 (Group) NPI is the number required for organizations such as clinics, group practices, and incorporated individuals who provide health care services and receive payment. For MDHHS, the Group NPI must be reported in the billing provider loop or field. [1]

There are five different CHAMPS Enrollment Types, read through the definitions below to determine the appropriate Enrollment Type.

  • Individual/Sole Proprietor:

    • Individual/Sole Proprietor: A 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.

    • Rendering/Servicing: A Rendering/Servicing provider is one who provides services through a Group, Facility, Agency, Organization or an Individual/Sole Proprietor. A Rendering/Servicing provider does not bill directly to Michigan Medicaid. The Billing Provider that is associated to this applicant type, submits claims and receives payments for the Rendering/Servicing provider. This Billing Provider must be approved in CHAMPS prior to the submission of a new enrollment application for a Rendering/Servicing provider.

  • 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.

  • Billing Agent: All new Billing Agent enrollments must also be completed utilizing the CHAMPS system. This process replaces the paper enrollment using the "Billing Agent ID Request" form. All providers who are associated to a Billing Agent will not be able to complete a new enrollment until the Billing Agent has been approved in CHAMPS.

  • Facility/Agency/Organization (FAO): A Facility / Agency / Organization (FAO) provider is an entity that provides health care services. An FAO includes Hospitals, Nursing Facilities, Laboratories, etc., and have a Type 2 NPI number associated to them. Providers who need to associate to an FAO will need to wait until the FAO enrollment application has been approved in CHAMPS.

  • Atypical: The Center for Medicare and Medicaid Services (CMS) defines atypical providers as providers that do not provide health care. 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.  [2]

 


[1]Michigan Medicaid Provider Manual chapters BIlling & Reimbursement for Dental, BIlling & Reimbursement for Institutional and BIlling & Reimbursement for Professionals, Section 2.3 within each chapter

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