Medical Billing Services in California, Built for Medi-Cal, IPAs and Knox-Keene Rules
California Billing manages the full claim lifecycle for California physician practices, from charge entry and scrubbing to payment posting, denials and patient balances. Every workflow is set up for how California payers actually pay: Medi-Cal managed care plans, delegated IPAs and medical groups, Noridian for Medicare, and commercial plans regulated by the DMHC.
HIPAA compliant · BAA with every client · CPC-certified coders · No long-term contract
Results California Practices Can Measure
Averages across active California clients. Results vary by specialty, payer mix and documentation quality.
Why Medical Billing in California Breaks Generic Workflows
Most billing companies run one national workflow. California does not reward that. A single practice can bill Medi-Cal fee-for-service, three or four Medi-Cal managed care plans, several delegated IPAs, Medicare and a dozen commercial plans, each with its own rules for eligibility, authorization and claim routing.
Claims sent to the wrong payer
When a patient is assigned to an IPA or medical group, the health plan often is not the payer. The Division of Financial Responsibility (DOFR) decides who pays. Claims sent to the plan instead of the delegated group are denied or bounced, and the filing clock keeps running.
Medi-Cal managed care denials
Each Medi-Cal managed care plan sets its own authorization rules, claim edits and portal. A workflow built for one plan creates repeat denials on the next.
Missed filing deadlines
California rules give contracted providers at least 90 days from the date of service to file with Knox-Keene plans, but many IPA contracts hold you to exactly that. A two-week charge lag uses up a sixth of the window.
Underpaid out-of-network claims
AB 72 sets the payment for certain out-of-network services at in-network facilities. Practices that do not check the payment standard or use the dispute process leave money on the table.
Credentialing gaps
A provider who is not enrolled with a plan, or not linked to the right IPA, generates claims that can never be paid. Medi-Cal enrollment through PAVE adds its own timeline.
No visibility by payer or location
Multi-site groups in Los Angeles, the Bay Area and the Central Valley carry different payer mixes. One blended A/R report hides which payer, site or provider is causing the problem.
What Our California Medical Billing Services Include
Our outsourced medical billing service covers every step between the patient visit and the final payment. You keep control of your EHR; we do the billing work inside it.
How Every Claim Moves Through Our Billing Process
- 1
Patient eligibility and routing.
We confirm coverage and identify whether the plan, the IPA or the medical group pays.
- 2
Charge capture.
Charges are entered within 24–48 hours of the visit to protect the filing window.
- 3
Coding review.
Certified coders check codes, modifiers and medical necessity.
- 4
Scrubbing.
Claims pass payer-specific edits before they leave our system.
- 5
Submission.
Claims go out electronically through the clearinghouse or payer portal.
- 6
Rejection triage.
Front-end rejections are fixed and resent within 24 hours.
- 7
Payment posting.
Payments are posted and checked against your contracts.
- 8
Denials, A/R and patient balances.
Anything unpaid is worked until it is paid, appealed or closed with a reason.
California Payer and Compliance Expertise
This is where California billing is won or lost. Our team works these rules every day.
Medi-Cal Fee-for-Service and Managed Care
We bill Medi-Cal fee-for-service and the Medi-Cal managed care plans that serve your counties, such as L.A. Care, Health Net, IEHP and others. We track each plan's authorization rules, claim formats and dispute steps, and we keep up with CalAIM changes that affect benefits and billing.
IPA, Medical Group and Capitation Billing
Many California patients are assigned to an IPA or medical group under a delegated model. We read the DOFR to route claims correctly, bill fee-for-service carve-outs outside the capitation, and submit complete encounter data so your capitation and quality payments reflect the care you deliver.
AB 72 and Out-of-Network Claims
AB 72 took effect July 1, 2017. It protects patients from surprise bills for non-emergency services by out-of-network providers at in-network facilities. The plan pays the greater of its average contracted rate or 125% of Medicare fee-for-service. When a payment falls short, we take it through the plan's dispute process and, where it applies, the Independent Dispute Resolution Process run by the DMHC or CDI.
Knox-Keene Timely Filing and Prompt Payment
Under Title 28 CCR § 1300.71, Knox-Keene plans and their capitated groups must give contracted providers at least 90 days from the date of service to file, and 180 days for non-contracted providers. Contracted clean claims must be paid within 45 working days, with interest owed automatically when they are late. We track every one of these clocks.
Medicare Part B Through Noridian
Noridian Healthcare Solutions is the Medicare Administrative Contractor for California (Jurisdiction E). We bill Part B to Noridian's local coverage rules and handle redeterminations when claims are denied.
Specialties We Bill for Across California
Each specialty has its own codes, modifiers and payer rules. Our coders are assigned by specialty.
Serving Practices Statewide
We support practices in all 58 California counties from our San Diego office, with remote billing teams that work inside your EHR.
Why California Practices Choose California Billing
California-only focus.
We bill for California practices only, so our rules, payer contacts and workflows are built for this market.
Certified people on every account.
CPC and CCS-certified coders and a named account manager who knows your practice.
Full transparency.
You see every claim, every denial and every dollar in your own EHR and in our monthly reports.
Audit before we start.
We review your current A/R, denials and contracts before onboarding and show you what we will fix first.
HIPAA and security.
We sign a Business Associate Agreement with every client and limit access to the staff on your account.
Switching Billing Companies in Four Steps
- 01
Free revenue review.
A 20-minute call and a review of your A/R, denial trends and payer mix.
- 02
Custom billing plan.
Targets for clean claim rate, days in A/R and collections, with pricing in writing.
- 03
Transition with no billing gap.
We connect to your EHR, set up payer enrollments and ERAs, and work your old A/R while new claims go out.
- 04
Ongoing billing and reporting.
Daily billing, monthly reports and a standing review with your account manager.
California Medical Billing FAQs
Straight answers about cost, Medi-Cal, IPAs, filing limits and switching billing companies.
Most practices pay a percentage of collections, typically 4–8% depending on specialty, volume and scope. We quote a fixed rate in writing after the free revenue review, with no setup fee.
Can't find what you're looking for? Contact our billing specialists