What is LEA Billing?

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:

  1. Provide comprehensive health services to eligible Medi-Cal students and, when applicable, to their families
  2. 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
  3. 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
  1. Complete the following forms with DHCS
    1. Contract
    2. Application for electronic claims submission
    3. Application for electronic remittance advice
    4. Application for verification of student Medi-Cal eligibility
  2. Create an LEA Billing Option Collaborative
  3. Verify licenses, credentials, and educational requirements for district health providers
  4. Create a LEA Billing Option audit Plan
  5. Develop a plan for Retro Billing – 12 months prior and one time only
  6. Develop WEB or paper billing system
  7. Verify Medi-Cal student eligibility
  8. Train staff on program requirements and billing procedures
  9. Submit electronic or paper claims to DHCS for reimbursement
  10. Prepare annual DHCS LEA Billing Option report
  11. Prepare annual Cost and Reimbursement Comparison Schedule (CRCS)
SBR Makes it Easy

What we do at SBR...

  1. Prepare DHCS forms for district signature
  2. Train staff on LEA Billing Policies and Procedures
  3. Program setup for proper documentation
  4. Perform initial Compliance Review
  5. Electronic data base management
  6. Upload facility for legacy data
  7. WEB/Paper Claims Training
  8. Identify students Medi-Cal population
  9. Electronic Claims Submission
  10. Automatic Claims Reconciliation
  11. Audit Review
  12. Assist with preparation of DHCS Provider Participation agreement
  13. Prepare Cost and Reimbursement Comparison Schedule (CRCS)
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