Medical Billing Services in California
Since 1 January 2026 both California regulators run one clock: Health & Safety Code 1371 gives a DMHC-regulated health care service plan 30 calendar days from receipt to reimburse a complete claim or notify the claimant in writing that it is contested or denied, Section 1371.35 applies the same 30 calendar days to claims for emergency services and care, and Insurance Code 10123.13 imposes the same deadline on CDI-regulated health insurers — the 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. Medi-Cal allows six months following the month in which services were rendered, 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.
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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 is what the Department of Managed Health Care administers over health care service plans, while the Department of Insurance regulates insurance-licensed products — the split decides which regulator you escalate a stalled claim to. AB 72 surprise billing protections predated the federal No Surprises Act, adding state-specific dispute resolution requirements. Prompt pay was rewritten effective 1 January 2026: Health & Safety Code 1371, Health & Safety Code 1371.35 and Insurance Code 10123.13 now all require payment, contest or denial within 30 calendar days of receipt, with 15 percent annual interest running after that and no separate HMO, working-day or paper-claim count (verified 17 September 2026). 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
What billing costs in California
We publish one national rate card and bill California practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
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: Health & Safety Code 1371 requires a DMHC-regulated health care service plan to reimburse a complete claim, or notify the claimant in writing that it is contested or denied, no later than 30 calendar days after receipt. Section 1371.35 applies the same 30 calendar days to claims for emergency services and care, and Insurance Code 10123.13 imposes the same deadline on CDI-regulated health insurers. Interest accrues at 15 percent per annum from the first calendar day after that period, and a plan or insurer that does not automatically include the accrued interest owes the greater of $15 or 10 percent of it. These are the versions operative 1 January 2026 under AB 3275 (Stats. 2024, Ch. 763): the former working-day counts, the separate HMO deadline and the paper-claim deadline are gone. Verified against California Legislative Information on 17 September 2026.
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
Health & Safety Code 1371 requires a DMHC-regulated health care service plan to reimburse a complete claim, or notify the claimant in writing that it is contested or denied, no later than 30 calendar days after receipt. Section 1371.35 applies the same 30 calendar days to claims for emergency services and care, and Insurance Code 10123.13 imposes the same deadline on CDI-regulated health insurers. Interest accrues at 15 percent per annum from the first calendar day after that period, and a plan or insurer that does not automatically include the accrued interest owes the greater of $15 or 10 percent of it. These are the versions operative 1 January 2026 under AB 3275 (Stats. 2024, Ch. 763): the former working-day counts, the separate HMO deadline and the paper-claim deadline are gone. Verified against California Legislative Information on 17 September 2026.
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 AuditHow 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?
The Knox-Keene Act is the statute the Department of Managed Health Care administers, and it covers health care service plans — HMOs plus the plan-licensed PPO and EPO products — while the California Department of Insurance regulates insurance-licensed PPO and indemnity products. Which regulator a patient's product sits under decides the grievance route and who you escalate a stalled claim to. The payment deadline itself no longer differs: since 1 January 2026 it is 30 calendar days on both sides. We handle both workflows for your practice.
What happens if a payer misses the California prompt-pay deadline?
California rewrote these rules effective 1 January 2026 under AB 3275 (Stats. 2024, Ch. 763). Health & Safety Code 1371 gives a DMHC-regulated health care service plan 30 calendar days from receipt to reimburse a complete claim or send written notice that it is contested or denied; Section 1371.35 applies the same 30 calendar days to claims for emergency services and care; Insurance Code 10123.13 imposes the same 30-calendar-day deadline on CDI-regulated health insurers. There is no separate HMO deadline, no working-day count and no electronic-versus-paper split. Interest accrues at 15 percent per annum from the first calendar day after that period, and a plan or insurer that does not automatically include the accrued interest owes the claimant the greater of $15 or 10 percent of that interest. We track every clean claim against these deadlines, flag stalled payments in our A/R reports, and escalate to the DMHC for plan-regulated products or to the CDI for insurer-regulated products. Deadlines verified against the official code text published by California Legislative Information on 17 September 2026. Medi-Cal allows six months following the month of service; commercial claims run 90-180 days.
Services for California practices
Specialties we bill for
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Billing help for your California practice
Tell us the specialty and we will come back on what your California payer mix actually changes — filing windows, the state's prompt-pay clock, and which plans your claims are going to. Written findings in 3–5 business days.
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Services in California
Specialties in California
- Mental Health Billing in California
- Dermatology Billing in California
- Cardiology Billing in California
- Family Practice Billing in California
- Mental Health Billing Services in California
- Dermatology Billing Services in California
- Urgent Care Billing Services in California
- Emergency Medicine Billing Services 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.
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