Since FY 1991-92, DPH has contracted with AmeriChoice to provide fiscal intermediary services for the CHIP Hospital and Physician Programs. As San Francisco’s CHIP fiscal intermediary, AmeriChoice is primarily responsible for claims processing and adjudication, but has additional responsibilities for provider relations, policy dissemination and data reporting, and assistance to the County in program management.

CHIP funds are disbursed to the participating hospitals and physicians through the fiscal intermediary. The claims adjudication and payment process is summarized as follows:

Participating hospitals and physicians submit claims, according to their respective claims processing and payment schedules, to the fiscal intermediary.
The fiscal intermediary adjudicates submitted claims and sends an invoice for payment of allowed claims to the County.
The County approves the invoice and authorizes payment.
The County issues a check for payment to the fiscal intermediary.
The fiscal intermediary pays hospitals and physicians with accompanying remittance advices and explanations of benefits.

Approximately 20,000 claims representing the same number of encounters are processed annually for participating CHIP hospitals and physician providers.

The fiscal intermediary electronically accepts specific financial and utilization encounter data, and patient demographic data, from modified claims submission forms [hospitals (UB-82) and physicians (HCFA-1500)] in accordance with HIPAA requirements. It also makes prospective payments without submission of claims, and makes retrospective payments by adjudicating claims and paying for approved items. It may make at the end of the year, for CHIP Community Physicians, a supplemental payment if excess funds are available. The fiscal intermediary prepare CHIP MICRS data reports, other ad hoc statistical information, and participates in management of the program.

Lastly, AmeriChoice also administers the CHDP Treatment Program by paying claims for dental services provided to children as a follow-up to a CHDP screening exam.

For further information on the fiscal intermediary or the CHIP Hospital and Physician Programs, please call (510) 523-2811 or write to:

AmeriChoice
San Francisco CHIP Program Fiscal Intermediary
8840 Complex Drive, Suite 300
San Diego, CA 92123