Common Contracts
1 similar null contracts
Medi-Cal Rx Electronic Remittance Advice (ERA) Authorization Agreement FormNovember 30th, 2021
the “835-Transaction.” The ERA Authorization Agreement must be filled out by an active Medi-Cal Rx provider. Non-providers can receive electronic remittances if designated as a receiver by a provider; however, the authorizing provider must submit the agreement. This authorization remains in effect until Medi-Cal Rx receives written notification from the provider of its termination, or until Medi-Cal Rx or appointing authority deems it necessary to terminate the agreement.
