CHAMPS

Provider Enrollment Release 8/21/18

Timeframe for application of CHAMPS provider enrollment requirement to groups of practitioners within the PIHP/CMH system: In applying the deadlines outlined in the attached press release, Medicaid claims will be valid only if the provider of Medicaid services are enrolled as per the following timeframes:

  1. All typical providers (professional health care providers that provide health care services to beneficiaries), except for prescribers, who work within the PIHP/CMH system and do not provide Medicaid services that are billed to the private Medicaid Health Plans, are not be required to enroll in CHAMPS at this time. The due date for CHAMPS enrollment for these providers will be announced by MDHHS at some time in the future.
  2. All prescribers in the PIHP/CMH system, however, even those who do not provide services that are billed to the Medicaid Health Plans, must be enrolled in CHAMPS prior to July 1, 2019.
  3. All typical providers (professional health care providers that provide health care services to beneficiaries) who provide Medicaid services that are billed to the Medicaid Health Plans, even those who work within the PIHP/CMH system, must be enrolled in CHAMPS prior to January 1, 2019.
  4. All atypical providers (who provide support services for beneficiaries) are not required to enroll in CHAMPS at this time. The due date for CHAMPS enrollment for these providers will be announced by MDHHS sometime in the future.

Typical providers are health care professionals that provide health care services to beneficiaries. They must meet education and state licensing requirements and have assigned National Provider Identifiers (NPI). Examples include, but are not limited to, physicians, physician assistants, certified nurse practitioners, dentists and chiropractors.

At this time, contracted Integrated Care Organizations (ICOs), Prepaid Inpatient Health Plans (PIHPs) and MI Choice Waiver agencies are exempt from this requirement.

For dates of service on or after July 1, 2019, MDHHS Fee-for-Service and Medicaid Health Plans will prohibit payment for prescription drug claims written by a prescriber who is not enrolled.

CHAMPS enrollment neither requires nor mandates providers in a managed care network to accept Fee-for-Service Medicaid beneficiaries. CHAMPS enrollment is used solely to screen providers participating in Medicaid.

Resources:

Providers who have questions about the enrollment process or require assistance may contact the MDHHS Provider Enrollment Help Desk at 1 (800) 292-2550.