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For pharmacy providers who bill L&I directly
Point-of-sale system (POS) for reimbursement
Use the NCPDP Payer sheet ver. 5.1 (142 KB PDF) for billing format.
POS hours:
- 6 a.m. to midnight Monday through Saturday.
- 6 a.m. to 10 p.m. on Sunday.
To receive remittance advice in the HIPAA compliant EDI 835 transaction, see
Pharmacy 835 Companion Guide (606 KB PDF / 3 min).
Get Help Downloading Files (files open in a new window).Paper forms for reimbursement
For State Fund claims
- Statement for Pharmacy Services form (F245-100-000).
OR - Statement for Compound Prescription form (F245-010-000).
- Dispensing compound prescriptions require prior authorization.
For Crime Victim claims
- Statement for Pharmacy Services - Crime Victims form (F800-058-000).
OR - Statement for Compound Prescription - Crime Victims form (F800-067-000).
- Dispensing compound prescriptions require prior authorization.
Helpful billing information
To prevent a rejection to your prescription (71 - Prescriber not covered) use the:
- Prescriber's state license number.
- Individual L&I provider number * or National Provider ID (NPI).
- DEA number only if doctor is an endorsing prescriber.
* L&I provider numbers for large groups, clinics or hospitals are no longer accepted for prescription billing.
Pharmacy providers who submit bills on their own behalf and also use a third party pharmacy biller need to be sure to use the correct service provider ID. Payments will be made to the account associated with the submitted service provider ID.
