LEA Program Annual Report Package for Returning Providers
Updated: October 3, 2014
LEA MEDI-CAL BILLING OPTION PROGRAM
ANNUAL REPORT PACKAGE
EXTENDED SUBMISSION DEADLINE: NOVEMBER 30, 2014
MANDATORY LEA PROGRAM ANNUAL REPORT REQUIREMENT
As specified in the Local Educational Agency (LEA) Medi-Cal Billing Option Program Provider Participation Agreement (PPA), participating LEAs must submit a LEA Program Annual Report Package on or before October 10th of the same fiscal year, whether or not the LEA submitted Medi-Cal claims during the fiscal year. Non-submission may result in suspension from the LEA Program. The submission deadline has been extended to November 30, 2014.
The FY 2013-14 Annual Report Package for returning LEAs reports on claims received during FY 2013-14, and updates FY 2014-15 provider and consortium information, and includes:
IMPORTANT: Returning LEAs that have changed their LEA Name, Services Address, EIN, or NPI must complete the PPA for New Providers to update their information with DHCS, and not the FY 2013-14 Annual Report Package for returning LEAs.
(completed correctly)
LEA ANNUAL REPORT PACKAGE QUESTIONS / CONTACTS
Please direct any questions regarding the LEA Annual Report Package to: LEA@DHCS.CA.GOV
DOCUMENTATION RETENTION REQUIREMENTS
The LEA Annual Report and supporting documentation must be maintained by each LEA for a minimum of three years from the date of submission to DHCS and the information contained therein must be verifiable by DHCS Audits and Investigations staff, if necessary.
COPIES OF PRIOR FY LEA ANNUAL REPORT
To obtain a copy of your prior year LEA Annual Report, you must use the following instructions:
Send your request to: LEA@dhcs.ca.gov.
Your email request MUST meet the following guidelines:
A) Subject Line: “(FY) LEA Annual Report Request – (NPI Number)”
Example: 2008-2009 LEA Annual Report Request – 1234567890
B) Copy (CC): All LEA staff members who will also need a copy of the prior LEA Annual Report
C) Body: (NPI Number), (Official LEA Name), (Contact Name and Phone Number)
Example:1234567890, Official LEA Name USD, Terry Administrator (817) 980-0987
COPIES OF PRIOR FY LEA PPA
To obtain a copy of your prior year LEA PPA, you must use the following instructions:
1. Send your request to: PEDCorr@dhcs.ca.gov.
Your email request MUST meet the following guidelines:
A) Subject Line: “(FY) LEA Annual Report Request – (NPI Number)”
Example: 2008-2009 LEA Annual Report Request – 1234567890
B) Copy (CC): All LEA staff members who will also need a copy of the prior LEA Annual Report
C) Body: (NPI Number), (Official LEA Name), (Contact Name and Phone Number)
Example:1234567890, Official LEA Name USD, Terry Administrator (817) 980-0987
