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Billing for LEA Services

Each LEA is required to complete a Biller Application Agreement (Form 6153) and Payment Receiver Agreement (Form 6246) to receive reimbursement for practitioner services billed through the LEA Medi-Cal Billing Option Program. 
*  The signature(s) on these forms must be from the individual who authorized by the LEA to bind contracts for the  
   district.  Reimbursements will be delayed if the individual(s) who signs these forms is not authorized to bind
   contracts.
 
CMC Enrollment Procedures
 
CMC Enrollment Checklist
 
Form 6153 - Payment Receiver Agreement
 
Form 6246 - Biller Application Agreement
 
Additional billing information can be found at http://files.medi-cal.ca.gov/pubsdoco/forms.asp
Last modified on: 7/3/2015 5:29 PM