Claims

We want to make the claims process as easy as possible for our health care providers.

To learn about submitting your claims electronically, please contact our Provider Network Operations Department at pno@lacare.org or (213) 694-1250.

PM-160 Forms

Complete the order form below to request copies of the PM-160 Forms.

• Click on this sentence to order PM-160 Forms.
• Click on this sentence to learn how to fill out the PM-160 Request Form. (PDF)

CMS 1500 Forms

• Click on this sentence to print the CMS 1500 Claim Form. (PDF)
• Click on this sentence to learn how to fill out the CMS 1500 Claim Form. (PDF)

If you have any questions about a previously submitted claim, contact our Claims Department at 1 (888) 4LA-CARE (452-2273).

Important Information for School-Based Clinics:

A Third-Party Billing Manual for California's School Health Centers (PDF)