Revenue Cycle Management Services Built for California Healthcare
One accountable team from the first eligibility check to the final payment.
A coverage problem at the front desk becomes a denial. A missed authorization becomes a write-off. A slow follow-up becomes 120-day AR. Our end-to-end RCM team owns every step of your revenue cycle, under California's payer rules, so problems are fixed where they start and revenue reaches your account faster.
- Medi-Cal, Medicare, commercial and IPA expertise
- Certified CPC and CCS coders
- Works in your EHR
- HIPAA compliant with signed BAA
- No long-term contract
What Is Healthcare Revenue Cycle Management?
Healthcare revenue cycle management (RCM) is the set of administrative and financial processes that turns a patient visit into collected revenue, from scheduling and insurance verification through coding, claim submission, payment posting, denial resolution and patient billing. Healthcare revenue cycle management services take ownership of those processes so every dollar your providers earn is billed correctly and collected.
RCM is broader than medical billing. Billing is the claims step in the middle. RCM includes everything that decides whether that claim gets paid: what happened before the visit, how the visit was documented and coded, and what happens after the payer responds.
Front-End, Mid-Cycle and Back-End Revenue Cycle for California Practices
Front-end
Scheduling, registration, eligibility and benefits verification, prior authorization, credentialing and payer enrollment, patient cost estimates
Typical owner without RCM: Front desk
Mid-cycle
Clinical documentation, charge capture, medical coding, charge entry, claim scrubbing and submission
Typical owner without RCM: Providers, coders, billers
Back-end
Payment posting, underpayment review, denial management, appeals, AR follow-up, patient statements and collections, reporting
Typical owner without RCM: Billing office
Where Revenue Leaks in the Cycle
- 1Before the visit
Inactive coverage, missed authorizations, providers not yet credentialed with the payer.
- 2During the visit
Undocumented services, missed charges, wrong modifiers, undercoding.
- 3At submission
Missing data, payer-specific edits, wrong payer or IPA.
- 4After submission
Unworked denials, underpayments nobody checks, AR that ages past timely filing.
- 5Patient balances
Unclear statements, uncollected copays and deductibles.
Most leakage starts upstream and shows up downstream. That's why one team owning the whole cycle recovers more than separate vendors each owning a piece.
Our End-to-End Revenue Cycle Management Services
Choose the full cycle, or the stages where you need help most. Each service links to its own page.
Front-End: Eligibility, Prior Authorization, Credentialing
Insurance Eligibility and Benefits Verification
Coverage, benefits, Share of Cost, IPA assignment and patient cost estimates confirmed 48–72 hours before every visit.
Learn morePrior Authorization
Requirements checked, clinical packets built and approvals secured before the date of service, including Medi-Cal TARs and IPA authorizations.
Learn moreCredentialing and Provider Enrollment
Medi-Cal PAVE, Medicare PECOS, CAQH, commercial plans and IPAs, so every provider can bill from day one.
Learn moreMid-Cycle: Coding, Charge Capture, Claims
Back-End: Payment Posting, Denials, AR, Patient Billing
Payment Posting
ERA and EOB posting, contractual adjustment review and underpayment flags against your fee schedules.
Denial Management
Every denial worked within 48 hours, appealed or corrected, and traced to its root cause.
Learn moreAR Follow-Up and Recovery
Claims followed up from day 30, and aged AR recovered on contingency.
Learn morePatient Billing
Clear statements, payment plans and patient support, compliant with California's medical debt rules.
Reporting and Revenue Analytics
RCM Reporting
Monthly KPI dashboard covering collections, denials, AR aging and payer performance, with a named owner for every action item.
Revenue Cycle Management Services in California: What's Different Here
California is the largest and most layered payer market in the country. National RCM vendors treat it like any other state, and California practices pay for that in denials, delays and missed rights.
Medi-Cal and Managed Care
About 13.3 million Californians are enrolled in Medi-Cal managed care, assigned by county to plans such as L.A. Care, IEHP, CalOptima Health, Health Net, Molina and Partnership HealthPlan. Every stage of the cycle changes with Medi-Cal: PAVE enrollment, Share of Cost at check-in, Treatment Authorization Requests, Medi-Cal Rx for pharmacy and a six-month billing limit. We build those rules into each stage.
IPAs, Medical Groups and Capitation
Much of California's HMO care runs through IPAs and medical groups that take capitation and pay claims on the health plan's behalf. That means a claim, an authorization or a dispute often goes to the IPA, not the plan. We use each plan's Division of Financial Responsibility (DOFR) to route every claim to the party that actually pays.
California Laws That Shape Your Revenue Cycle
| Law or rule | What it means for your revenue |
|---|---|
| Knox-Keene Act, 28 CCR 1300.71 | Plans can't set filing limits under 90 days (contracted) or 180 days (non-contracted), and must give 365 days' notice to recoup overpayments |
| 28 CCR 1300.71.38 | Formal provider disputes: 365 days to file, plan must decide within 45 working days |
| AB 3275 | DMHC-regulated plans must pay complete claims within 30 calendar days, with 15% annual interest after that |
| SB 1120 (2025) | Medical necessity denials must be made by a licensed clinician, not an AI tool alone |
| SB 306 | Plans report prior authorization approval rates; from 2028, services approved 90%+ of the time are exempt from prior authorization |
| SB 1061 (in effect since July 1, 2025) | Providers can't report patient medical debt to credit agencies, and medical debt contracts must carry a required notice |
| CMIA | California's medical privacy law, stricter than HIPAA in places, governs how we handle patient data |
We don't just comply with these rules. We use them: tracking plan deadlines, claiming late-payment interest and filing disputes when a payer runs out the clock.
California Payers We Work With
We know each payer's portal, edits, filing limits and dispute process, because we work in them every day.
| Payer category | Payers and networks |
|---|---|
| Government | Medi-Cal fee-for-service (DHCS), Medicare Part B (Noridian JE), Medicare DMEPOS, TRICARE West, VA Community Care, California Children's Services, Family PACT |
| Medi-Cal managed care | L.A. Care, Health Net Community Solutions, Molina Healthcare, Inland Empire Health Plan, CalOptima Health, Partnership HealthPlan, Anthem Blue Cross Partnership Plan, Blue Shield Promise, Kaiser Permanente, Alameda Alliance for Health, San Francisco Health Plan, Santa Clara Family Health Plan, Health Plan of San Mateo, CalViva Health, CenCal Health, Central California Alliance for Health, Gold Coast Health Plan, Kern Health Systems, Health Plan of San Joaquin, Community Health Group |
| Commercial | Blue Shield of California, Anthem Blue Cross, UnitedHealthcare, Aetna, Cigna, Health Net, Sharp Health Plan, Western Health Advantage, Covered California plans |
| Medicare Advantage and duals | SCAN Health Plan, Alignment Health, Humana, UnitedHealthcare AARP, Wellcare by Health Net, Kaiser Senior Advantage, D-SNPs |
| Delegated networks | IPAs, medical groups and MSOs, including Optum, Heritage Provider Network, Hill Physicians, Prospect Medical and regional IPAs |
| Other | Workers' compensation carriers and MPNs, auto and personal injury, out-of-network claims |
EHR and Practice Management Systems We Work In
Keep the system your providers already know. Our EHR integration team works directly inside your EHR, practice management system and clearinghouse, so there's no data migration, no new software to learn and no disruption to your schedule. Access is secure and role-based: each team member sees only what their work requires, and every action is logged for a full audit trail.
| Category | Systems |
|---|---|
| Enterprise and hospital EHRs | Epic, Oracle Health (Cerner), MEDITECH |
| Ambulatory EHR and PM | athenahealth, eClinicalWorks, NextGen, AdvancedMD, Tebra (Kareo), DrChrono, CureMD, CareCloud, Practice Fusion |
| Specialty systems | ModMed (dermatology, orthopedics, ophthalmology), WebPT (therapy), SimplePractice and TherapyNotes (behavioral health), CentralReach (ABA) |
| Clearinghouses and portals | Availity, Office Ally, Waystar, Optum (Change Healthcare), Trizetto, payer provider portals, Medi-Cal Provider Portal, Noridian portal |
What System Expertise Means for You
Faster onboarding
We already know your system's workflows, reports and claim edits.
Cleaner claims
We configure fee schedules, payer IDs and scrubber rules correctly from day one.
Better reporting
We build KPI reports from your system's own data, so the numbers match what you see.
RCM for Every Practice Type and Specialty in California
Practice Types
Independent Physician Practices
Full-cycle RCM for practices without a dedicated billing department.
Multi-Specialty Groups
Specialty-specific coding and payer rules under one team and one report.
Hospitals and Health Systems
Professional fee billing, outpatient AR, denial and underpayment recovery.
Ambulatory Surgery Centers
Facility coding, implant billing, authorization and multiple-procedure payment checks.
FQHCs and Community Clinics
Medi-Cal managed care, PPS and wrap-around payments, CalAIM services.
Billing Companies and MSOs
Overflow capacity for coding, AR or denials under your brand.
Specialties and Their RCM Challenges
| Specialty | The revenue cycle problem we solve |
|---|---|
| Behavioral health and psychiatry | Carve-out payers, session limits, telehealth rules, Medi-Cal specialty mental health |
| ABA therapy | Unit-based authorizations, BCBA credentialing, H-code billing, secondary payers |
| Physical, occupational and speech therapy | Visit limits, timed codes, 8-minute rule, plan-of-care renewals |
| Orthopedics and spine | Surgical authorizations, implants, global periods, DME |
| Cardiology | Diagnostic testing authorizations, professional and technical components, device monitoring |
| Radiology and imaging | Radiology benefit managers, site-of-service rules, contrast billing |
| Oncology and infusion | Drug authorizations, J-codes, buy-and-bill, underpayments |
| Dermatology | Cosmetic vs medical, pathology, Mohs coding |
| OB/GYN | Global maternity packages, Medi-Cal pregnancy aid codes, Family PACT |
| Primary care and pediatrics | High-volume E/M, preventive vs diagnostic, CCS, capitation reconciliation |
| Urgent care | Same-day eligibility, high-volume claims, out-of-area HMO rules |
| Gastroenterology, pain management, urology, podiatry, anesthesiology | Procedure-heavy coding, authorizations and bundling edits |
Get a Free RCM Audit
We'll review 90 days of your claims, remittances and AR and show you where your revenue cycle is leaking, by stage, in five business days.
Why practices choose us
- Medi-Cal, Medicare, commercial and IPA expertise
- Certified CPC and CCS coders
- Works in your EHR
- HIPAA compliant with signed BAA
- No long-term contract