Get Enroll As Group Provider Quick Reference - State Of Michigan - Michigan

This guide provides a comprehensive overview of how to complete the Enroll As Group Provider Quick Reference for the State of Michigan online. By following these instructions, users can ensure a smooth application process.

Follow the steps to accurately fill out the form online.

1. Press the ‘Get Form’ button to access the form, which will open in your preferred editor for completion.
2. Log in to the CHAMPS system using Single Sign-On (SSO), following the prompts on the login screen.
3. Select the appropriate Provider Type from the options provided in the enrollment process.
4. Complete the Basic Information section, ensuring all required fields marked with an asterisk (*) are filled out.
5. Proceed by clicking the ‘Submit’ button to move to the next step.
6. Add Locations by clicking the ‘Add Locations Details’ hyperlink, and input the necessary address details, validating them as required.
7. Add Specialties, if desired, by clicking the ‘Add Specialties’ hyperlink and completing the required fields.
8. Specify the Mode of Claim Submission by selecting your preferences under the ‘Add Mode of Claim Submission’ section.
9. If applicable, associate a Billing Agent by clicking the ‘Associate Billing Agent’ hyperlink and filling in the required information.
10. Enter Ownership Details by clicking the ‘Add Ownership Information’ hyperlink and providing necessary ownership data.
11. If needed, add Taxonomy Details by selecting the ‘Add Taxonomy Details’ link and entering the appropriate information.
12. Complete the Enrollment Checklist by answering the required questions displayed on the checklist page.
13. Submit the Enrollment Application for Approval by confirming your entries and clicking the final submission options.
14. Finally, you can save changes, download, print, or share the completed form as necessary.

Get started on completing your documents online today!