CHIP (Children's Health Insurance Program)
Children's Health Insurance Program
State-administered federal program providing health coverage to children in families with incomes too high for Medicaid but too low for private coverage.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- Children's Health Insurance Program
- Primary sources
- 1
- Workspace handoff
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Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CHIP is operated jointly by CMS and the states. CHIP coverage often parallels Medicaid for clinical purposes but has separate eligibility and benefit specifics.
How it shows up in your practice
State CHIP plans may be administered by Medicaid MCOs. Verify CHIP enrollment as you would Medicaid.
Sources
- CMS — Medicare Administrative Contractorshttps://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs
Look up CHIP rules in Ask D3
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D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedicaidJoint federal-state program providing health coverage to certain low-income individuals, families, pregnant women, elderly, and people with disabilities.
- GlossaryMedicaid MCOA managed care organization contracted by a state to deliver Medicaid benefits.
- GlossaryFPL (Federal Poverty Level)Annual income thresholds published by HHS used to determine eligibility for federal programs.
- GlossaryMAC LCD ArticleA Local Coverage Article published by a MAC to provide billing, coding, or coverage clarification that does not rise to the formal LCD.
- GlossaryMedicare Administrative Contractor (MAC)CMS-contracted regional entity that processes Medicare claims, makes coverage decisions, conducts provider education, and handles first-level appeals.
- GlossaryState Medicaid PlanEach state's CMS-approved plan describing eligibility, benefits, provider participation, and payment for Medicaid.
- GlossaryRural Health ClinicA federally certified clinic in an underserved rural area that bills Medicare under a special all-inclusive rate methodology.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.