Medical Billing Services in California
California Health & Safety Code 1371.35 requires health plans to pay clean claims within 30 working days for electronic and 45 working days for paper submissions — a rule that shapes every clean-claim workflow for California practices. Anthem Blue Cross anchors California's commercial payer mix, which means fee-schedule mastery and timely appeals are non-negotiable for practices operating in the state. California Medicaid enforces a 180-day timely filing window, while commercial payers in the state run 90-180 days — deadlines that discipline every claim queue we manage. Our remote billing team builds California-specific workflows around these rules, with payer-level edits, MCO portal automation, and appeals templates tuned to how California plans actually adjudicate.
The California Billing Landscape
California operates one of the largest and most complex healthcare markets in the world. Medi-Cal, the state's Medicaid program, covers over 15 million enrollees through a county-organized managed care system with plans like L.A. Care, Health Net, Molina, CalOptima, and Inland Empire Health Plan, each with county-specific rules and prior authorization workflows. The commercial market is dominated by Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, and UnitedHealthcare, with Kaiser's closed-network model creating unique referral billing dynamics. California's Knox-Keene Act governs HMO regulation, requiring distinct billing procedures separate from PPO workflows. AB 72 surprise billing protections predated the federal No Surprises Act, adding state-specific dispute resolution requirements. The prompt pay law under Health & Safety Code 1371.35 mandates payment within 30 working days for electronic claims with 15% annual interest penalties. California's diverse geography creates vastly different practice environments — Bay Area and LA practices navigate high overhead and competitive payer negotiations, while Central Valley and rural Northern California providers deal with higher Medi-Cal patient ratios and access challenges. Telehealth parity under AB 32 requires equivalent reimbursement for virtual visits.
Who We Serve in California
Our California client mix skews toward solo practices, group practices, community health centers , plus ambulatory surgery centers and telehealth providers. We work with providers in Los Angeles, San Francisco, San Diego and across the rest of the state, all remotely.
Major Metros Served
Payer Landscape in California
Medi-Cal (managed care through county-organized and commercial health plans) routes members through L.A. Care Health Plan, Health Net, Molina Healthcare and 3 more plans, each with its own authorization rules and fee schedule. On the commercial side, Anthem Blue Cross, Blue Shield of California, Kaiser Permanente drive the bulk of California claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in California run 180 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. California's prompt-pay statute: California Health & Safety Code 1371.35 requires health plans to pay clean claims within 30 working days for electronic and 45 working days for paper submissions. Non-compliant plans owe 15% annual interest plus $10 per claim penalty.
Medicaid Program
Medi-Cal (managed care through county-organized and commercial health plans)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
California Health & Safety Code 1371.35 requires health plans to pay clean claims within 30 working days for electronic and 45 working days for paper submissions. Non-compliant plans owe 15% annual interest plus $10 per claim penalty.
California Billing Regulations & Compliance
The California Department of Insurance (CDI) and Department of Managed Health Care (DMHC) sets the rules our California billing workflows have to satisfy. Surprise billing in California: California AB 72 protects patients from surprise medical bills for non-emergency out-of-network care at in-network facilities. The federal No Surprises Act provides additional protections. Telehealth parity: California AB 32 requires health plans to reimburse telehealth services on the same basis as in-person services. Medi-Cal covers telehealth including audio-only visits.
State Insurance Regulator
California Department of Insurance (CDI) and Department of Managed Health Care (DMHC)
Surprise Billing Protection
California AB 72 protects patients from surprise medical bills for non-emergency out-of-network care at in-network facilities. The federal No Surprises Act provides additional protections.
Telehealth Billing Parity
California AB 32 requires health plans to reimburse telehealth services on the same basis as in-person services. Medi-Cal covers telehealth including audio-only visits.
Common Questions
Common questions about medical billing services in California.
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Get a Free Billing Audit arrow_forwardHow do you handle Medi-Cal managed care billing?
Medi-Cal managed care plans like L.A. Care, Health Net, and Molina each have county-specific rules and different prior auth requirements. Our team manages the payer-specific workflows for each plan your practice is contracted with.
What about California's surprise billing rules?
AB 72 and the federal No Surprises Act both apply in California. We verify your out-of-network claims are billed correctly and help you navigate the independent dispute resolution process when reimbursements are below benchmark.
Do you work with practices across California?
Yes — from LA and the Bay Area to San Diego, Sacramento, and the Central Valley. Payer mix and reimbursement rates vary significantly by region, and our billing adapts accordingly.
How does California's Knox-Keene Act affect billing?
Knox-Keene regulates HMO plans in California, which means different claim submission and grievance procedures than PPO plans. We handle both HMO and PPO billing workflows for your practice.
What happens if a payer misses the California prompt-pay deadline?
California Health & Safety Code 1371.35 requires health plans to pay clean claims within 30 working days for electronic and 45 working days for paper submissions. Non-compliant plans owe 15% annual interest plus $10 per claim penalty. We track every clean claim against these California-specific deadlines, flag stalled payments in our A/R reports, and escalate to the California Department of Insurance (CDI) and Department of Managed Health Care (DMHC) when a payer defaults. Medicaid claims run a 180-day timely-filing window, commercial claims run 90-180 days — we build follow-up cadences around both.
Services for California practices
Specialties we bill for
Services in California
Specialties in California
Other Locations We Serve
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See where denials, follow-up delays, or workflow gaps may be hurting your California practice's collections.