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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.
- CHAMPS Enrollment Application: FAO User Guide - PDF
- Brain Injury Specialty FAO Enrollment Instructions- PDF
- 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