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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
- How to associate a billing agent and authorize the 835 - PDF
- Primary Specialty - PDF
- Quick Reference Guide - PDF
- Track Application - PDF, Recording
Specialty Specific Instructions
- Brain Injury Specialty Information- PDF
- Doula Enrollment Instructions- PDF
- Prescriber Requirement Information - PDF, Recording
Domain Administrator Resources
- Domain Administrator Functions -PDF
- Electronic Signature Agreement Cover Sheet MDHHS-5405
- Electronic Signature Agreement DCH-1401