Final Steps

Contact Your Adult Services Worker (ASW)

Upon completion of the CHAMPS enrollment application if you already have a beneficiary who needs to be authorized for services contact your beneficiary’s Adult Services Worker (ASW).

The ASW will schedule a face-to-face meeting with you and your beneficiary. The new provider must be present for this meeting.

Click here for a map of county offices

 

Submit the MSA-1904

Once services have been provided submit the MSA-1904 which include an accurate record of the authorized Home Help services that were provided on each day of the billing period. A separate MSA-1904 must be submitted for each beneficiary in which services were provided. 

Payment will not be released until the MSA-1904 has been received and verified by the beneficiary’s local county MDHHS office.

Click MSA-1904 to download a fillable version of the invoice.

Return to Agency Providers Page