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.

• CHAMPS Enrollment Application: Group User Guide
  
  • Provider Controlling Interest/Ownership Tip- PDF 
  • Quick Reference Guide - PDF 
• Revalidation Instructions - PDF
• Track Application - PDF

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 If the email address information is out of date or incorrect, enrolled providers will want to modify their enrollment information and submit it for approval.

835/Electronic Remittance Advice (ERA)

• How to associate a billing agent and authorize the 835/ERA - PDF
• Authorize a billing agent to receive the 835/ERA  - PDF
• End date the 835/ERA authorization - PDF

• Domain Administrator Functions -PDF
  • Quick Reference Guide
• Electronic Signature Agreement Cover Sheet MDHHS-5405
• Electronic Signature Agreement DCH-1401

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