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How to Become a Provider for the LEA Program

LEAs interested in participating in the LEA Medi-Cal Billing Option Program must obtain a National Provider Identification Number and complete a Provider Participation Agreement/Annual Report.    

Obtain a National Provider Identification (NPI) Number

The NPI Number is issued and obtained through the Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES). If you have not already obtained an NPI Number you must obtain one prior to applying to participate in the LEA Medi-Cal Billing Option Program.  The NPI Number is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard that does not carry any information about healthcare providers; such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. For information on how to obtain an NPI Number please use the following resources:
  • Information via the NPI Enumerator Phone Line: 1-800-465-3203 or TTY 1-800-692-2326.
  • or Apply on the web at: https://nppes.cms.hhs.gov
  • Provider Participation Agreement (PPA)/Annual Report (AR) Information

    A LEA provider (usually a school district or county office of education) must complete the following documents to apply for Provider participation in the LEA Program: 
     

    Local Educational Agency (LEA) Medi-Cal Billing Option Provider Participation Agreement (PPA).  This contract sets out responsibilities relative to participation in the LEA Medi-Cal Billing Option, including LEA provider and DHCS responsibilities, agreement activation and termination.  This is an 'evergreen' PPA and will remail in effect until terminated either by DHCS or the LEA provider. 

    Local Educational Agency (LEA) Medi-Cal Provider Enrollment Information Sheet.  This form is used by DHCS to create a Provider Master File (PMF), which is used by the Medi-Cal program to identify currently enrolled, valid Medi-Cal providers and to identify the services for which they are eligible to receive reimbursement under Medi-Cal. 

    Certification of State Matching Funds for LEA Services.  This certification must be completed annually as part of the annual report. It certifies that the funds budgeted for the fiscal year are non-federal, certified public LEA medi-Cal Billing Option Program eligible funds to finance LEA Program activities.

    Statement of Commitment to Reinvest.  This statement certifies that a local collaborative has been formed and includes among its responsibilities reinvestment of funds made available through participation in the LEA Medi-Cal Billing Option.  With this form, the LEA certifies that reinvested funds will remain within the school-linked support services identified in provision 7 of the Local Educational Agency (LEA) Medi-Cal Billing Option Provider Participation Agreement.

    * Provisions 8, 9, 10 and 11 of the Local Educational Agency (LEA) Medi-Cal Billing Option Provider Participation Agreement contain additional information about local collaboratives and reinvestment of LEA Funds. 
     
    The PPA/AR is available on the LEA website under the Tools and Templates Heading
     

     If you have any questions or need additioal information please send an email to LEA@DHCS.CA.GOV

    Last modified on: 7/5/2016 1:29 PM