Division of Public Welfare

BUREAU OF HEALTH CARE FINANCING ADMINISTRATION

Håfa Adai, Welcome to the Bureau of Health Care Financing Administration webpage!


Mission

The mission of BHFCA is to administer local and federal health care programs to assist low income individuals and families who are uninsured or have adequate insurance coverage and ensuring that the quality of health care is available and accessible for both on-island and off-island.


Inside the Bureau of Health Care Financing Administration

 

Program Management Section

The Program Management section is responsible for the financial and program management support; development, monitoring & evaluation of the program state plan, policies and procedures, operations, manuals, and rules and regulations.

 

Operations Section (Claims Processing)

The operations section oversees the utilization control, claims processing unit, EPSDT/Medicare buy-In, off-Island referral coordination and claims intake/file.

 

Quality Management Section (Benefit Coordination)

The Quality Management section is responsible for maintaining and developing the quality management of the Operation & Program Management Section and benefit coordination for prior authorization and medicaid fraud and control unit.


Contact Us

DPHSS Bureau of Health Care Financing Administration
155 Hesler Place
Hagatna, Guam 96910


Our Goals

  • To ensure that quality health care is available and accessible for Medicaid/MIP recipients seeking health care for either on-island or off-island services.

  • To process on a timely basis claims submitted by health care providers for services rendered to Medicaid/MIP recipients.

  • To continue to seek and implement methods of cost containment to the Medicaid/MIP Programs.

  • To Plan, organize, coordinate, and implement changes to Medicaid/MIP operations, policies and claims processing system in order to comply with Health Insurance Portability and Accountability Act (HIPPA) in order to avoiding federal sanctions.

  • To administer the Enhance Allotment Plan to dual Medicare eligible for prescription drugs.

  • To keep up with the timely submission of local and federally mandated reports requested on a quarterly and annual basis

  • To establish the Medicaid Integrity Program within the Bureau of Health Care Financing Administration.


Program Management Section: 

Office Tel: (671) 735-7475

Office Fax: (671) 735-7476

Provider Enrollment: (671) 735-7472 or Email: annabelle.estrada@dphss.guam.gov


Operations Section:             

Claims Intake/File: (671) 300-7330 / 7332

Off Island Referral: (671) 300-7348 or Email: Angela.Ecube@dphss.guam.gov

EPSDT/Medicare Buy-In: (671) 735-7237 or Email: clarasue.santos@dphss.guam.gov


Quality Management Section

Office Tel: (671) 735-7470

Office Fax: (671) 735-7476

Prior Authorization: (671) 735-7473 / 7474

Quality Control Unit: (671) 474-7231

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