Type 1 NPI and CHAMPS enrollment instructions
If you need a Type 1 NPI only (if you bill under a TIN or business name, you will also need a Type 2), follow the steps below to register for a Type 1 and enroll in CHAMPS.
Step 1: Register for a Type 1 NPI
There are three options to obtain an NPI:
- Apply through the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/#/. Individual providers must create a username and password through the Identity and Access Management System, then log in to NPPES using that username and password.
- Mail a paper application, Form CMS-10114 NPI Application/Update Form, to the NPI Enumerator address listed on the form. To request a hard copy application, call 800-465-3203 or TTY 800-692-2326, or email firstname.lastname@example.org.
- Give permission to an electronic file interchange organization to submit application data through a bulk enumeration process.
Step 2: Register the Type 1 NPI with CHAMPS for Michigan Medicaid through Healthy Kids Dental and Healthy Michigan Plan
Here is the link to register: https://milogintp.michigan.gov. See the enrollment guide here to enroll your Type 1 NPI as a rendering/servicing provider, associating to Delta Dental Plan of Michigan (“Delta Dental”). There will be 10 steps all together. You will need to complete all required steps, as outlined below. If optional, you may skip it.
- Fill out the Basic Information (anything with an asterisk is required). Applicant Type: Select “Rendering/Servicing Only.” After step 1 of the CHAMPS enrollment, you will get a notice of successful completion of that step and an Application ID number. Your application is not complete at this point; you must move forward with the remaining steps.
- Click “Add” then select “Dental” from the Provider Type. Select the Specialty or General Dentist. Skip the End Date. In the Available Subspecialties box, you will have four choices – choose “No Subspecialty.” Use the double arrows to move to the Associated Subspecialties box. Click “OK.” Then click the “Primary Specialty” tab. Change the drop-down from none to the other No Subspecialty option. No need to change the dates; leave the board Certified and Eligible as no. Save and close. Then close again.
- Select Provider ID from the drop-down. Use the Delta Dental ID number: 4181610.
- Select State Professional License from the drop-down. Use the full 10-digit license number of the DDS (the leading numbers for MI are 2901XXXXXX). Use the current date as the Start Date and Skip the End Date.
- Optional-You may skip.
- Taxonomy for General Dentist: 1223G0001X; Endo: 1223E0200X; Pediatric: 1223P0221X; Prostho: 1223P0700X; Ortho: 1223X0400X; Oral Surgery 1223S0112X. Use the current date as the Start Date and skip the End Date.
- Optional-You may skip.
- Optional-You may skip .
- Answer each question. You may request a Retro Enrollment date up to one year. Place the Retro Enrollment date in the comments section.
- It will take a few minutes to load; click on the “Next” button. It will take you to the terms and conditions page; click on the small box on the button, then click “Submit.”
You may also call CHAMPS at 800-292-2550 and ask for assistance enrolling as an individual sole, rendering/servicing provider associating to Delta Dental.
Step 3: Add Type 1 NPI to your claims
When submitting a Michigan Medicaid claim to Delta Dental (Healthy Kids Dental, Healthy Michigan Plan, Medicare Advantage, etc.), the State of Michigan requires use of the rendering service provider NPI on the claim.
- Type 1 (individual NPI) goes in box 54.
- Type 2 (billing NPI) goes in box 49.
Please be sure your practice management system also reflects the appropriate NPI number in this field for electronic claims submission.