Individual/Sole Proprietor

An Individual/Sole Proprietor is a provider that owns his/her 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. Most resources are provided in both PDF and Adobe Recording formats.

• Individual Enrollment Checklist - PDF (The intent of this resource is to provide a document that can be prefilled with the required information for completing a provider enrollment application to allow for ease of completion.)
• CHAMPS Enrollment Application: Individual/Sole Proprietor User Guide
  • Step 1: Provider Basic Information - PDF, Recording
  • Step 2: Add Locations - PDF, Recording
  • Step 8: Add Provider Controlling Interest/Ownership Details - PDF, Recording
    • Additional Ownership Tip - PDF
  • Primary Specialty - PDF 
  • Quick Reference Guide - PDF  
  • Track Application - PDF, Recording

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 If the email address information is out of date or incorrect, enrolled providers will want to modify their enrollment information and submit it for approval.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

Specialty Specific Instructions

• Brain Injury Specialty Information- PDF
• Doula Enrollment Instructions- PDF
• Prescriber Requirement Information - PDF, Recording

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

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