Children's Health Insurance Program (CHIP)
Beginning March 1, 2012, all Children’s Health Insurance Program (CHIP) clients will obtain their pharmacy benefits through a managed care health plan.
How it Works
Pharmacies that want to participate in the CHIP program must first be enrolled to provide Medicaid services through the Vendor Drug Program. An additional agreement must be completed and returned to Medicaid/CHIP Contract Management. Once enrolled, pharmacies with claims billing issues should contact the appropriate managed care plan.
Identifying CHIP Cardholder Numbers
CHIP cardholder identification numbers begin with an alpha character followed by eight digits. Some communication to CHIP recipients may show a nine-digit number called the CHIP Client Identification Number (CIN). If the CIN does not include an alpha character, the pharmacy should convert the lead digit to an alpha character as described in the Vendor Drug Pharmacy Provider Procedure Manual, specifically section 4.1. Client Identification Numbers. Failure to correct the cardholder ID prior to transmission may result in error code 52 ("Non-matched Cardholder ID"). Pharmacies can use the Vendor Drug real-time eligibility verification methods to identify CHIP cardholder ID numbers and determine which managed care health plan a client is enrolled with.
After March 1, the designation of a drug as generic or brand may vary between managed care plans. Therefore, the co-pay amount may vary for the same drug for clients enrolled in different plans.