Michigan Medicaid Provider Enrollment: CHAMPS, Fees, Screening

To enroll as a Michigan Medicaid provider, you submit an application through CHAMPS, the online portal run by the Michigan Department of Health and Human Services (MDHHS), backed by a valid professional license, a National Provider Identifier (NPI), credentials specific to your provider type, and ownership disclosures. Michigan Medicaid provider enrollment requirements apply not only to providers who bill Medicaid directly but also to those who only order, prescribe, or refer services for Medicaid beneficiaries. Institutional providers also owe a $750 application fee for calendar year 2026.¹

Who Has to Enroll

Any provider who delivers services to Michigan Medicaid beneficiaries, or who orders, prescribes, or refers services for them, must be screened and enrolled. This applies to both fee-for-service Medicaid and Medicaid Health Plan providers. If a referring or ordering provider’s information is missing from a claim, or that provider isn’t enrolled, the claim won’t be paid.²

If you’re already enrolled in Medicare and only intend to submit Michigan Medicaid claims for Medicare cost-sharing on behalf of dual-eligible beneficiaries, you can choose a restricted enrollment option called “Medicare Cost Share” during the CHAMPS process. Medicare provider types that Michigan Medicaid doesn’t recognize must complete full enrollment instead.²

What You Need Before You Apply

Every provider requesting enrollment must submit credentials verifying eligibility, and the required documents depend on provider type.³

Physicians: state medical license, proof of board certification in your specialty, and a W-9.
Clinical laboratories: CLIA Certificate, state laboratory license, proof of lab specialties, and a W-9.
Medical suppliers and DME providers: state license (or sales tax number if no state license applies), a list or brochure describing the supplies you provide, and a W-9.
Hospitals and nursing facilities: fiscal year end date, state license, proof of Medicare certification from CMS, CLIA Certificate, and a W-9.
Ambulance providers: state license and a W-9.
All other provider types: state license and a W-9.

You also need an NPI, the standard identifier required under federal law for healthcare transactions, and you’ll be asked to disclose ownership and control interests in your practice or organization during the application.⁴

How the CHAMPS Application Works

Enrollment happens through the Community Health Automated Medicaid Processing System (CHAMPS), the state’s web-based Medicaid management system.⁵ You create a CHAMPS account and enter your NPI, tax identification number, and practice location. You then complete the Medicaid Provider Enrollment Application, which asks for your professional qualifications, supporting documentation (licenses, certifications, liability insurance), and ownership disclosures.

Once you submit the application with all required attachments, MDHHS reviews it. Processing typically takes about one week. Incomplete applications and higher-risk screenings take longer.

Risk-Based Screening

Federal regulations require MDHHS to assign every applicant a categorical risk level — limited, moderate, or high — and screen accordingly. If you could fit into more than one category, MDHHS applies the highest level of screening.⁶

Limited risk: MDHHS confirms that you meet federal and state requirements for your provider type, verifies your license (including licenses in other states), and runs database checks before and after enrollment.
Moderate risk: everything in the limited category, plus an on-site visit to your practice location.
High risk: everything in the limited and moderate categories, plus a criminal background check and fingerprinting.

Your risk level can be raised to high regardless of provider category if MDHHS has placed you under a fraud-related payment suspension, you have an existing Medicaid overpayment, or you’ve been excluded from the OIG or another state’s Medicaid program within the past 10 years. The same escalation applies if you’re enrolling within six months of MDHHS lifting a temporary enrollment moratorium on your provider type.⁶

The Application Fee

Institutional providers (hospitals, nursing facilities, home health agencies, DME suppliers, and similar organizations) must pay an application fee when initially enrolling, revalidating enrollment, or adding a new practice location. For calendar year 2026, the fee is $750.¹

Individual physicians and non-physician practitioners don’t owe the fee. Providers already enrolled in Medicare or another state’s Medicaid or CHIP program — or who have already paid the fee to one of those programs — are also exempt.⁷ If paying would cause genuine financial hardship, you can request a waiver in CHAMPS and upload a letter to MDHHS explaining why. MDHHS reviews hardship requests on a case-by-case basis.⁸

After MDHHS Approves You

Approval brings you into a participation agreement that spells out your obligations: following federal and state Medicaid regulations, maintaining standards of care, keeping accurate records, and submitting claims correctly.

Most Michigan Medicaid beneficiaries are enrolled in managed care health plans rather than fee-for-service Medicaid. To serve those beneficiaries, you’ll need to contract separately with one or more Medicaid Health Plans. Each plan runs its own credentialing process and has network-specific requirements around care coordination, quality metrics, and payment.

Reimbursements are issued by tax identification number, and all payments owed to every provider under a given TIN are consolidated into a single payment. To receive payments by direct deposit rather than paper check, register for Electronic Funds Transfer through the Michigan Department of Technology, Management and Budget.⁹ Setting up EFT early avoids delays with your first reimbursement.

Keeping Your Enrollment Active

Enrollment isn’t permanent. Federal rules require MDHHS to revalidate every provider’s enrollment at least once every five years, regardless of provider type.¹⁰ Revalidation confirms that your credentials, practice information, and ownership disclosures are still accurate. Institutional providers owe the $750 fee again at revalidation.¹

Between revalidation cycles, you must notify MDHHS within 35 days of any change to your enrollment information, such as a new practice address, a change in ownership, or updates to managing employees.¹¹ You submit updates through a CHAMPS modification. Missing the 35-day window can jeopardize your enrollment.

Compliance You’re Signing Up For

HIPAA Privacy and Security

As a Medicaid provider, you’re a HIPAA-covered entity. You need written privacy policies, workforce training, and administrative, technical, and physical safeguards to prevent unauthorized access to protected health information.¹² The Security Rule adds specific requirements for electronic health information, including access controls and transmission security.¹³

Record Retention

Michigan law requires licensed healthcare providers to retain medical records for a minimum of seven years from the date of service.¹⁴ Federal Medicaid rules may apply independently to billing and financial records, and MDHHS or CMS can audit records going back several years. Keep both clinical and billing records for at least seven years, and don’t destroy anything that’s the subject of a pending audit or investigation.

Ongoing Disclosures

Before MDHHS enters into or renews a provider agreement, you must disclose any person with an ownership or control interest in your practice, along with any agents or managing employees. MDHHS can refuse to enroll or re-enroll you if any of those individuals have been convicted of a criminal offense related to their involvement in Medicare, Medicaid, or another federal healthcare program.¹⁵

Fraud and Abuse Oversight

The federal Medicaid Integrity Program directs states to review provider activities for fraud, waste, and abuse through claim audits, cost report reviews, and provider education.¹⁶ MDHHS expects providers to submit regular reports on service delivery and claims. Discrepancies between what you report and what the data shows can trigger audits.

Penalties for Non-Compliance

Michigan enforces its own Medicaid False Claim Act (MCL 400.601 through 400.615). A provider who receives benefits through fraud, false statements, or concealment of material facts faces a civil penalty of $5,000 to $10,000 per false claim, plus triple the damages the state suffered. A criminal prosecution is not required for this civil liability to attach; MDHHS can pursue the money without a conviction.¹⁷

Criminal penalties run separately. Filing a false claim is a felony carrying up to four years in prison and a fine up to $50,000. Soliciting or receiving kickbacks in connection with Medicaid-covered goods or services is also a felony, punishable by up to four years and a $30,000 fine. The most serious violations carry up to 10 years in prison, as does another offense by a provider with three or more prior convictions under the Act.¹⁷

MDHHS can also suspend or terminate your enrollment for failing to meet program requirements. If MDHHS determines you were overpaid, you’ll have to repay those amounts regardless of whether fraud was involved.

If MDHHS Denies or Sanctions You

If MDHHS denies your enrollment application, imposes sanctions, or takes any other adverse action, you can challenge it. You may request either an internal conference with MDHHS or an appeal for an administrative hearing. The request must be in writing and received within 30 calendar days of the adverse action notice.¹⁸ Miss the deadline and the adverse action becomes final.

If the internal process doesn’t resolve the issue, you can escalate to a formal hearing before an administrative law judge, where you can present witnesses and additional evidence. If the decision goes against you, you have 60 days from the date of the final administrative decision to file a petition for judicial review in Michigan Circuit Court.¹⁹ Track that 60-day deadline from the moment you receive the final decision.

1
Federal Register. Medicare, Medicaid, and Childrens Health Insurance Programs Provider Enrollment Application Fee Amount for Calendar Year 2026
2
Michigan Department of Health and Human Services. Medicaid Provider Manual – Ordering, Referring, and Attending Requirements
3
State of Michigan. Credentialing Requirements
4
Michigan Department of Health and Human Services. Provider Enrollment
5
Department of Health and Human Services. Community Health Automated Medicaid Processing System (CHAMPS)
6
eCFR. 42 CFR Part 455 Subpart E – Provider Screening and Enrollment
7
eCFR. 42 CFR 455.460 – Application Fee
8
State of Michigan. Facility/Agency/Organization Step 13 – Fee Payment
9
Michigan Department of Health and Human Services. Medicaid Provider Manual – Billing and Reimbursement
10
eCFR. 42 CFR 455.414 – Revalidation of Enrollment
11
Michigan Department of Health and Human Services. CHAMPS Instructions and Information
12
U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule
13
HHS.gov. Summary of the HIPAA Security Rule
14
Michigan Legislature. Michigan Code MCL 333.16213 – Record Retention
15
eCFR. 42 CFR 1002.4 – Disclosure by Providers and State Medicaid Agencies
16
Office of the Law Revision Counsel. 42 USC 1396u-6 – Medicaid Integrity Program
17
Michigan Legislature. Michigan Medicaid False Claim Act – Act 72 of 1977
18
Legal Information Institute. Michigan Administrative Code R 400.3404 – Request for Internal Conference or Appeal for Administrative Hearing
19
Michigan Department of Health and Human Services. Medicaid Provider Manual – Appeals and Judicial Review