Local Education Agency (LEA) Medi-Cal Billing Option Program offers districts a way to recover the costs of health services provided to special education students.
The purpose of the Local Educational Agency (LEA) Program is to:
Provide comprehensive health services to eligible Medi-Cal students and, when applicable, to their families
Allow Local Education Agencies to become Medi-Cal providers and bill the Medi-Cal program for the health services provided to students with an IEP by the medical professionals they employ
Facilitate reinvestment in health and social services for students and their families
Reimbursement is based upon a "fee-for-service" medical billing model.
How to Participate in LEA
Complete the following forms with DHCS
Contract
Application for electronic claims submission
Application for electronic remittance advice
Application for verification of student Medi-Cal eligibility
Create an LEA Billing Option Collaborative
Verify licenses, credentials, and educational requirements for district health providers
Create a LEA Billing Option audit Plan
Develop a plan for Retro Billing – 12 months prior and one time only
Develop WEB or paper billing system
Verify Medi-Cal student eligibility
Train staff on program requirements and billing procedures
Submit electronic or paper claims to DHCS for reimbursement
Prepare annual DHCS LEA Billing Option report
Prepare annual Cost and Reimbursement Comparison Schedule (CRCS)
SBR Makes it Easy
What we do at SBR...
Prepare DHCS forms for district signature
Train staff on LEA Billing Policies and Procedures
Program setup for proper documentation
Perform initial Compliance Review
Electronic data base management
Upload facility for legacy data
WEB/Paper Claims Training
Identify students Medi-Cal population
Electronic Claims Submission
Automatic Claims Reconciliation
Audit Review
Assist with preparation of DHCS Provider Participation agreement
Prepare Cost and Reimbursement Comparison Schedule (CRCS)