CHIP Physician Program
The CHIP Physician Program was also established in 1989 to distribute funds for uncompensated care. CHIP funds are used to reimburse eligible physician providers including: physicians or dentists providing services in offices located in San Francisco. The CHIP Physician Program receives claims from hundreds of physician and dental providers each year.
Funding for the CHIP Physician Program comes from a combination of State and local dollars. It should be noted that the CHIP new contracts physician allocation is used to reimburse CHDP follow-up treatment services.
90% of EMSA funds must be distributed to physicians and dentists for provider services. 10% of EMSA funds may used for administrative costs, including claims processing by the fiscal intermediary. No local general fund dollars may be used for administration. State funds earn interest that is distributed to providers in the same manner and for the same purpose as the principal funds.
Eligible patients are those who cannot afford to pay for the services provided by the physician, and for whom payment will not be made through private coverage or by any program funded in whole or in part by the federal government.
Prior to billing the CHIP Program, the physician must inquire as to whether there is a responsible third-party source of payment and must bill for payment of services. If no payment is received after three months either from the patient or responsible third-party, the physician may seek reimbursement from the CHIP Program. Once receiving payment from CHIP, the physician must cease all collection efforts to obtain payment from the patient for whom CHIP payment was received.
Eligible services include physician services for emergency medical conditions, when services are provided in general acute care hospitals or in a standby emergency room; obstetric services provided to pregnant women from the time of conception until 90 days following the end of the month in which the pregnancy ends; and pediatric services provided to persons from birth to 21 years of age including attendance at labor and delivery. Pediatric dental services are also covered.
For further information on the CHIP Physician Program, please call (415) 575-5711.