Medical Billing Services in California
Medical billing for California practices that bill Medi-Cal, Medicare and commercial plans, including practices that work with IPAs and medical groups.
Billing support for California practices
California billing has its own rhythm. Medi-Cal is one of the largest Medicaid programs in the country, most of its members are in managed care plans, and many of those plans delegate claims to IPAs and medical groups. A single practice can end up billing the state, several health plans and several delegated groups for the same type of visit, each with its own portal and rules.
We take over that work remotely. Our team checks eligibility and the responsible payer before the visit, submits clean claims to the right entity, works every denial and follows up on aging balances, so claims don't stall between a plan and a medical group.
We support practices across California, including Los Angeles, San Diego, San Jose, San Francisco, Sacramento and Fresno. Learn more about our medical billing, denial management, claims processing and revenue cycle management services.
What we handle for California practices
- Medicare Part B claims through Noridian, the Medicare contractor for California (Jurisdiction E)
- Medi-Cal fee-for-service and Medi-Cal managed care plan claims
- Claims to delegated IPAs and medical groups, routed to the entity that is actually responsible
- Tracking of the Medi-Cal six-month billing limit and its payment reductions
- Commercial payers such as Blue Shield of California, Anthem Blue Cross and Health Net
- Monthly reports on collections, denials and days in A/R
California billing rules at a glance
The payer rules that shape how California claims get paid. Plan contracts can differ, so we confirm each payer's current requirements during onboarding.
Medicaid program
Medi-Cal (fee-for-service and Medi-Cal managed care plans)
Medicaid filing limit
Six-month billing limit after the month of service; payment is cut by 25% in months 7–9 and 50% in months 10–12, and claims after 12 months are denied unless a valid delay reason applies
Medicare contractor (Part A/B)
Noridian Healthcare Solutions (Jurisdiction E)
Major commercial payers
Blue Shield of California, Anthem Blue Cross, Health Net, UnitedHealthcare, Aetna and Cigna
Common California denials and how we prevent them
Wrong payer or delegated group
The claim goes to the health plan when the member's IPA is responsible, or the reverse. We confirm the responsible entity at eligibility so the claim goes to the right place the first time.
Late Medi-Cal claims
Claims submitted after the six-month limit are paid at a reduced rate or denied. We submit within days of the visit and track every open claim against the deadline.
Authorization gaps
Managed care plans and medical groups often require referrals or prior authorization. We check requirements before the visit and track every request.
Specialties we bill for in California
Frequently Asked Questions
Do you bill Medi-Cal managed care plans and IPAs?
Yes. We bill Medi-Cal fee-for-service, Medi-Cal managed care plans and delegated IPAs and medical groups, and confirm which one is responsible for each patient before the claim goes out.
What is the Medi-Cal timely filing limit?
Original Medi-Cal claims should be received within six months following the month of service. Claims received in months 7 to 9 are paid at 75% and in months 10 to 12 at 50%, and claims after 12 months are denied unless an approved delay reason applies.
Who is the Medicare contractor for California?
Noridian Healthcare Solutions processes Medicare Part A and Part B claims for California as the Jurisdiction E Medicare Administrative Contractor.
Do you need to be located in California to work with us?
No. We work remotely through secure access to your EHR, practice management system and clearinghouse, so practices anywhere in California work with us the same way.
How much does medical billing cost for a California practice?
We charge a percentage of the payments we successfully collect, with no upfront or setup fees. The percentage depends on your specialty and claim volume, so we quote it after a free review.
Other states we serve
Ready to Get Paid Faster?
Get a free billing review. We'll look at your current collections, denials and A/R and show you where revenue is being lost.