Automated Form Completion Now Available: POS Network/Internet Agreement

December 30, 2020

The Medi-Cal Point of Service (POS) Network/Internet Agreement form is now available electronically. The DocuSign application form will be accessible from the initial page of the Transaction Services log-in page of the Medi-Cal Provider website.

Providers must have this form on file for a variety of reasons, including downloading PDF versions of the Remittance Advice Details and submitting POS, Computer Media Claims (CMCs) and Real-Time Internet Pharmacy claim transactions.

Other uses of the POS Network/Internet agreement are included in the Transaction Enrollment Requirements chart.

Providers who submit their POS Network/Internet agreement form electronically will have the agreement processed more quickly and save on envelope and postage costs.

The paper version of the Medi-Cal Point of Service (POS) Network/Internet Agreement form will still be available. Providers can request a hard copy agreement form from the Telephone Service Center (TSC) at 1-800-541-5555 or print the form from the Medi-Cal Provider website Forms page, under the “Billing (CMC, EFT Payments, Hardcopy & POS” heading. TSC is available from 8 a.m. to 5 p.m., Monday through Friday, except national holidays. Border providers and Out-of-State billers billing for in-state providers call (916) 636-1200.

Updated manual pages will be released in a future Medi-Cal Update as needed.