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 NPIs:

• 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 (Organization) 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 Organization NPI must be reported in the billing provider loop or field. [1]

CHAMPS Enrollment Types

Read through the definitions below to determine the appropriate Enrollment Type.

• Individual/Sole Proprietor:
  • Individual/Sole Proprietor: An individual/Sole Proprietor is a provider that owns their 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 provides services through a Group, Facility, Agency, Organization, or 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 has 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]

• Electronic Visit Verification (EVV): As outlined in MMP 23-42 and MMP 23-76 impacted program providers of Personal Care Services (PCS) are required to enroll in CHAMPS with an atypical enrollment type. 

  Programs include:

  • Behavioral Health
  • Community Transition Services (CTS)
  • Home Help
  • MI Choice
  • MI Health Link

  When enrolling in CHAMPS Agencies will have the below specialty and subspecialty options except a Fiscal Intermediary (FI). A Fiscal intermediary will enroll with a specialty of Fiscal Intermediary and have additional subspecialty options. 

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