Non-county hospitals must submit an annual Enrollment Form and comply with the CHIP Hospital Conditions of Participation in order to participate in the program. Hospitals may submit claims to the CHIP fiscal intermediary for reimbursement of uncompensated care provided to indigent persons. There are three prospective quarterly payment periods during the year, and one retrospective payment period. Claims are submitted once per year. Reimbursement is made for uncompensated costs as determined by multiplying the hospital's approved submitted charges by its ratio of costs to charges (RCC).

Upon receiving payment from CHIP, the participating hospital agrees to cease all collection efforts to obtain payment from the patient for whom CHIP payment was received. However, the hospital may continue to seek payment from a responsible third-party payer or continue collection on a repayment schedule based on the patient's ability to pay for the costs of services rendered.

DPH contracts with AmeriChoice to provide fiscal intermediary services. The payment process is summarized as follows:

Participating hospitals submit claims to the fiscal intermediary according to a specified claims processing schedule.
The fiscal intermediary adjudicates submitted claims and sends an invoice for payment of approved claims to the County.
The County approves the invoice and authorizes payment to hospitals.
The County issues payment to check to the fiscal intermediary.
The fiscal intermediary pays hospitals with accompanying remittance advices and explanations of benefits.
Hospitals must submit claims information on a UB 82 billing form and a supplemental information form. Non-county hospitals also provide demographic information on each patient for whom reimbursement is requested.

Although prior authorization and other utilization review procedures are not used by the program, the County may audit providers and recoup funds to prevent erroneous payment of funds.

For further information on the CHIP Hospital Program, please call (510) 523-2811 or write to:

AmeriChoice
San Francisco CHIP Program Fiscal Intermediary
8840 Complex Drive, Suite 300
San Diego, CA 9212