Medical Billing Services for California Practices

• Medical billing. Charge review, claim preparation and submission across all payers, plus payment posting.
• Revenue cycle management. Eligibility through reimbursement, with live monthly performance reporting.
• Denial management. We find the cause of each denial, fix it and appeal within the payer's deadline.
• Credentialing and payer enrollment. Help with provider credentialing and payer enrollment. See our credentialing page for details.
• A/R recovery. Working aged balances before they pass filing and appeal limits.
• Billing audits. A review of your current billing to find lost revenue and repeat errors.

We work online, inside your practice management system or clearinghouse, and report to you every month. You don't need a local billing office.

Medi-Cal is California's Medicaid program, run by the Department of Health Care Services (DHCS). Its fee-for-service timeliness rules cost practices real money when claims go out late:

• Original claims must be received within six months following the month of service. For example, a service on April 15 must be received by the end of October.
• Claims received in the 7th to 9th month after the month of service are paid at 75% of the payable amount.
• Claims received in the 10th to 12th month are paid at 50%.
• Claims received after the 12th month are denied, unless an approved delay reason applies.
• Claims Inquiry Forms (CIFs) must be submitted within six months of the date on the Remittance Advice Details (RAD), and appeals within 90 days.

Sources: Medi-Cal Provider Manual, "Claim Submission and Timeliness Overview": Source, California Welfare and Institutions Code §14115: Source, and 22 CCR §51008: Source

Many Medi-Cal patients are enrolled in managed care plans, which have their own claim rules and contracts. We work with the payer rules in your state and check eligibility to find out which plan pays before we submit.

Medicare Part A and Part B fee-for-service claims in California are processed by Noridian Healthcare Solutions, LLC, the Medicare Administrative Contractor for A/B Jurisdiction E (JE). JE also covers Hawaii, Nevada and several Pacific territories. Noridian's local coverage determinations and claim edits apply to California providers.

Source: CMS, "Who are the MACs: A/B MAC Jurisdiction E (JE)": Source

Medicare claims generally must be filed within one calendar year of the date of service. Source: 42 CFR 424.44: Source

Health care service plans licensed under the Knox-Keene Act, which includes most HMOs and some PPOs, follow California Health and Safety Code §1371. The current text of §1371 requires a plan to pay a complete claim no later than 30 calendar days after receipt, or to notify you in writing within that time that the claim is contested or denied. Deadlines vary by plan type: insurance policies regulated by the California Department of Insurance, self-funded employer plans and Medi-Cal managed care contracts can follow different timelines, so check the current statute and your payer contract.

If a complete claim isn't paid on time, interest accrues at 15% per year and the plan must include it automatically. A plan that fails to include the interest owes an extra fee of $15 or 10% of the interest, whichever is greater.

Source: California Health and Safety Code §1371: Source

The related regulation, 28 CCR §1300.71, sets out claims settlement practices for these plans, including how to contest claims and dispute payments: Source

Insurance policies regulated by the California Department of Insurance, and self-funded employer plans, can follow different rules. We track each payer's timeline and follow up on late payments and missing interest.

We support physician practices and dental offices across California, including primary care, family and internal medicine, behavioral health, urgent care, pediatrics, OB-GYN, cardiology, neurology, pain management, podiatry, urology, labs and DME suppliers, plus general and specialty dentistry. See our specialties page for the full list.

Medical billing for California practices starts at 2.5% of collections. Your final rate depends on specialty, claim volume and the services you choose. Use the Plan Builder or request pricing for a quote.

Please don't send patient information through our forms. If you have questions about data handling, contact us and we'll walk you through our process.