Billing & RCM in California
California clinics don't lose money because they lack patients. They lose it in the gaps between Medi-Cal rules, Medicare Advantage prior auth, and commercial plans that treat the same CPT like three different languages. We run billing in California the way the payer mix actually behaves — not the way a national template hopes it will.
Outcomes practices see
First-pass clean claim rate
Typical A/R days after stabilization
Payer mix we work daily
What we handle in California
- Medi-Cal and Managed Medi-Cal claim scrubbing before submission
- Medicare Advantage prior-auth and referral chase that doesn't stall A/R
- Denial work that names the real root cause — not just the CARC code
- Weekly cash-flow visibility for multi-site Bay Area and SoCal groups
- Coding support for high-volume primary care, behavioral health, and specialty clinics
Walk into a California practice on a Tuesday and you'll hear the same story with different accents. Volume is fine. The bank account isn't. Claims sit because a managed Medi-Cal plan wants a different auth number than last quarter, or because a Medicare Advantage plan bounced a referral that was already in the chart.
Medi-Cal isn't one payer — treat it like one and you'll keep losing weeks
Medi-Cal fee-for-service, county plans, and managed care organizations each have their own quirks. We map your enrollment footprint before we touch live claims. If a location bills under the wrong plan code, no amount of "follow-up" fixes the denial pile. Billing in California starts with knowing which door the claim should walk through.
Commercial plans in LA and the Bay aren't gentler. United, Anthem Blue Cross, Health Net, and Kaiser-adjacent networks all have their own timely-filing and modifier habits. We don't pretend a Midwest denial playbook ports cleanly west.
A/R that ages past 60 days usually has a California-specific reason
It might be a missing CCS authorization. It might be a telehealth place-of-service that worked in 2022 and fails now. Or a secondary Medi-Cal claim that never crossed because the primary remittance never posted correctly. We dig before we resubmit. Blind resubmits just reset the clock.
You'll get a straight answer on what's recoverable and what should be written off. Nobody needs a dashboard that flatters the backlog.
Provider credentialing
CAQH, PECOS, state Medicaid, and commercial panels — so new providers aren't unbillable for a quarter.
