Join our network as a Community Health Worker
Effective Jan. 1, 2024, Michigan Medicaid will begin reimbursing Community Health Worker (CHW) services provided to our Medicaid members. To be reimbursed for your services, you must first enroll in our provider network.
Please note it can take up to 80 calendar days for us to process your enrollment.
Community Health Worker enrollment requirements
- CHW must be at least 18 years of age and possess a high school diploma or equivalent.
- CHW must be enrolled with CHAMPS
- Must have a Type 1 (Individual) National Provider Identifier (NPI) and complete an online application in the Community Health Automated Medicaid Processing System (CHAMPS).
- As part of the enrollment process, individually enrolled CHW’s must also associate their enrollment with at least one Medicaid-enrolled organization with a Type 2 (Group) NPI.
- The billing provider must have a Group/Organizational (Type 2) NPI or be an Individual Sole Proprietor with an Individual (Type 1) NPI. Associated billing providers may be employers or organizations the CHW is contracted with to perform services.
How to join our networks
Follow the steps below to complete your enrollment application. Be sure to follow them carefully and check that each step of your application is complete and accurate before moving on.
Missing or inaccurate information will delay your processing time. Applications missing either the W9 or CHAMPS enrollment may be rejected as incomplete.
Before submitting your enrollment application:
- Have your W9 saved to your computer
- Review our current Medicaid fee schedule for Community Health Worker providers. You'll find 2024 rates for Community Health Worker services posted to the Practitioner/medical clinic fee schedule as soon as they're available from MDHHS.
Submitting your enrollment application:
- Log into prism or create a prism account.
- Select Enrollments & Changes from the main menu, then choose New Individual Provider Enrollment. Follow the prompts to complete your enrollment request.
- While completing your New Individual Provider enrollment application, please use the information below for these required fields: ***For Community Health Worker enrollment only***
Practice Type = OTHER
Provider Specialty = Community Health Worker
CAQH ID number = Enter ‘00000000’
Provider State License Number = Enter ‘00000000’
License State = Enter ‘MI’
Note: To be eligible for Medicaid participation, you must be actively enrolled in CHAMPS.
- Check the status of your application
Once you submit your enrollment application, our team will receive an inquiry. You can check the status of your request and view comments from our team any time in prism by clicking on Enrollments & Changes and selecting the Inquiry ID. When your request is completed, you'll receive a comment from our team. Any time our team posts a comment, you'll receive an email notification.
Remember it can take up to 90 days for us to process your application. Due to the way our systems are set up, requesting a status update via prism may increase your waiting time. Please only submit an inquiry on your application through prism if you need to make a change. See “Find your network effective date” below for how to contact us if your application has exceeded 90 days.
Our process, once we receive your application:
- Contracting: Every provider must be under contract with us before they can be in our network. Learn more about provider contracts and agreements.
- Credentialing/Enrollment: We ensure providers meet our criteria to be approved as in-network. Once this has been completed, we enroll providers in our systems.
- Reimbursement: We configure each provider's reimbursement structure based on their contract.
Our review – what we look for
We review your application and supporting documents for completeness and verify your information. As detailed above, this process takes up to 90 calendar days.
Your application is complete when we've received, verified and/or completed the following:
- Completed application and signed attestation and release, including copies of professional liability insurance (minimum limits of $100,000/ $300,000)
- Must be at least 18 years of age and possess a high school diploma or equivalent, verified directly in the MDHHS application process
- CHAMPS enrollment verified, Medicaid only
- MDCH - Medical Services Administration Sanctioned Providers
- Office of Inspector General Sanctioned Provider Exclusion Database
- System for Award Management (SAM)
Find your network effective date
Once your request is complete, you'll receive a final comment from us in prism that includes your network effective date. You can begin billing for dates of service on the network effective date. We’ll also return the countersigned copy or your Provider Group Participation Agreement to you for your records.
Claims submitted before the network effective date may result in incorrect payment or denial.
If you haven’t received a confirmation email that the enrollment is complete within 90 calendar days of your submission, please send an email to email@example.com describing the delay. Include your Inquiry ID number in your email.
- Doula credentialing
- CHW credentialing
- Contracted POs and PHOs
- Credentialing criteria by provider type
- Organizational credentialing process
- Credentialing application process
- Behavioral health providers
- Adding a provider to your practice
- Confidentiality of credentialing information