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Professional

This page is intended for Professional providers and is categorized by provider type.

 

The following providers must use the ASC X12N 837P 5010 Professional format when submitting electronic claims or the Professional claims option via the CHAMPS Direct Data Entry(DDE) screens.

Advanced Practice Registered Nurses (APRNs), including Certified Nurse Practitioners (NPs), Certified Clinical Nurse Specialists (CNSs), Certified Nurse-Midwives (CNMs) Federally Qualified Health Centers

Medical Suppliers

Portable X-ray Suppliers
Ambulance Genetic Counselors Optical Companies Private Duty Nurses (Individually Enrolled)
Ambulatory Surgical Centers (ASC)

Hearing Aid Dealers

Optometrists

Rural Health Clinics (RHC)

Anesthesiologist Assistants

Hearing Centers Oral-Maxillofacial Surgeons School-Based Services

Certified Registered Nurse Anesthetists (CRNA)

Independent Diagnostic Testing Facilities

Orthotists and Prosthetists

Shoe Stores
Chiropractors Independent Laboratories

Physician Assistants

Urgent Care Centers
Community Mental Health Services Programs/Prepaid Inpatient Health Plans (CMH/PIHP)

Indian Health Centers

Physical Therapists

Doula Maternal Infant Health Program (MIHP) Physicians (MD & DO)
Family Planning Clinics

Medical Clinics

Podiatrists


CHAMPS Provider Contact Information

MDHHS utilizes provider email address information entered in the CHAMPS provider enrollment application to communicate with providers. Providers are responsible for maintaining accurate and valid email address information within their CHAMPS provider enrollment information. If email information is out of date or incorrect enrolled providers will want to modify their enrollment information and submit it for approval.

For instructions on how to update or modify email addresses reference the Provider Enrollment webpage step-by-step enrollment guide resources.

 


To access a resource click on the preferred file hyperlink.

Resources for all Professional Providers

Previously Recorded Webinars

 

Additional provider specialty-specific resources below


Ambulance


Certified Community Behavioral Health Clinics (CCBHC)

CCBHCs are non-profit or local government agencies that provide comprehensive and coordinated behavioral health services to all Michiganders, regardless of their insurance, ability to pay, place of residence, or age. CCBHCs are federally required to provide nine comprehensive behavioral health services, including 24/7 mobile crisis response and medication assisted treatment for substance use disorders.

Potential CCBHC Expansion
Providers seeking to participate in the demonstration must agree to meet all reporting timelines determined during expansion and outlined in the CCBHC Handbook, follow the CCBHC Demonstration Policy, meet all certification and operational requirements, visit Potential Provider Information webpage to learn more. CCBHCs currently participating in the demonstration may also submit requests to add new clinics or service areas. Barring a federal extension of the demonstration or MDHHS policy changes, the demonstration is set to end in September 2027.

For more information, visit the Potential Provider Information or Provider Information webpages.


Community Health Worker (CHW)

A CHW/community health representative (CHR) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between the health/social services and the community to facilitate access to services and improve service delivery's quality and cultural competence. The CHW/CHR is a non-licensed public health provider that facilitates access to needed health and social services for beneficiaries. CHW services focus on preventing disease, disability, and other chronic health conditions or their progression, and promoting physical and mental health. These services are designed to be person-centered and patient-driven, with a focus on beneficiary empowerment, fostering self-advocacy skills to promote personalized and effective diagnosis or treatment.

Resources

Policy Primer Video Series

The Michigan Department of Health and Human Services Behavioral and Physical Health and Aging Services Administration engaged stakeholders with its efforts to ensure a diverse perspective was captured to inform and provide recommendations to MDHHS around defining CHW services, qualifications, supervision, and other required policy elements. The Policy Primer Series consisted of four, short, recorded policy initiative updates which launched weekly beginning on April 17th. This series was created to support the sharing of Medicaid CHW policy initiative progress and to encourage active collaboration from you, the stakeholders. An additional video was released each week until May 8th, 2023. The topics included Managed Care Organization versus Community Provider Distinction, Provider Qualifications, and Covered Services and Reimbursement.

 


Community Transition Services (CTS)

As outlined in the policy bulletin, MSA 21-11,  CTS Agencies will be screened and enrolled in the Community Health Automated Medicaid Processing System (CHAMPS).  Additional CHAMPS Provider Enrollment Resources

  • Facility/Agency/Organization (FAO) Enrollment Instructions: PDF
  • Rendering/Servicing Enrollment Instructions: PDF

Doula 

As of January 1, 2023, Michigan Medicaid began reimbursing for doula services provided to individuals covered by or eligible for Medicaid Insurance. Doula providers seeking reimbursement for their professional services to Medicaid beneficiaries are required to be on the MDHHS Doula Registry and enrolled in CHAMPS as a Medicaid provider. Doulas must contact the Medicaid Health Plans before serving Medicaid Health Plan members. Review the applicable policy bulletin MMP 22-47 and MMP 24-40.

Enroll as a Provider

After enrolling in CHAMPS, doulas wishing to provide services to Medicaid Health Plan members must become credentialed with each Medicaid Health Plan in the doula’s geographic service area. Credentialing with Medicaid Health Plans is an extensive process and varies by plan; please note the process could take several months.

Verify the Beneficiary or Patient Eligibility

Verify Code Coverage and Restrictions

Submit or Bill the Claim

Doulas must submit claims for services provided to Medicaid Health Plan members to the Medicaid Health Plan. The Medicaid Health Plan reimburses the doula for services provided to MHP members. To identify which Medicaid Health Plan is associated with a specific county, refer to Medicaid Health Plans: List of Medicaid Health Plans Contact and Service Listing.


Durable Medical Equipment (DME)/ Medical Suppliers


Physician

 

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