Do you bill Medi-Cal?

Yes, both Medi-Cal fee-for-service and the county managed care plans. They are enrolled and worked separately, since a provider active with DHCS is not automatically loaded with every plan.

Our claims go through an IPA. Can you handle that?

Yes. Delegated arrangements are the norm in California. We route claims by the patient’s actual assignment rather than by the card, which is what stops the not-our-member denials.

Do you work with Kaiser?

For practices seeing Kaiser members under a contract or referral arrangement, yes. Kaiser’s structure means the claim path depends on the arrangement, so we confirm it before billing rather than assuming.

We are opening a second location in another county. What changes?

The Medi-Cal managed care plans change, and often the commercial contracts too. We handle it as a new payer set, including the enrollment work, rather than assuming the existing setup carries over.

California

Medical billing for California practices

California adds a layer most states do not: a large share of commercial and Medi-Cal business runs through IPAs and delegated medical groups, so the entity that pays the claim is often not the plan on the patient’s card. Billing that ignores the delegation sends clean claims to the wrong place.

Delegated risk and IPA claims

When a plan delegates claims payment to an IPA or medical group, the claim goes to the delegated entity and the plan will deny it as not their responsibility. The reverse is equally common. We identify the responsible payer from the patient’s assignment rather than the card logo, which removes a category of denial that otherwise repeats every month for the same patients.

Medi-Cal enrollment and county plans

Enrollment with DHCS is separate from being loaded with each county managed care plan a practice bills. Both are tracked, with revalidation dates held against deadlines, because a lapsed Medi-Cal enrollment stops payment without a warning email anyone reads in time.

Prior authorization volume

California commercial plans and Medi-Cal managed care both authorise heavily for imaging, therapy and specialty referrals. Authorizations are tracked to approval and attached to the claim, and the expiry date is watched, because an authorization that lapsed between approval and the date of service denies exactly like no authorization at all.

Medi-Cal

Medi-Cal managed care is organized county by county, so the plans a practice deals with depend on where it sits. A practice that opens a second location in another county is, for billing purposes, entering a new payer market.

Program: Medi-Cal
Administered by: California Department of Health Care Services (DHCS)
Managed care: Medi-Cal managed care plans, by county

Payers we work in California

Anthem Blue Cross of California
Blue Shield of California
Kaiser Permanente
Health Net
UnitedHealthcare
Medi-Cal managed care plans

Not an exhaustive list, and not a claim of network participation on your behalf — your contracts are yours. It is the payer mix we are set up to work in California.

Services available to California practices

Billing in California — common questions

Do you bill Medi-Cal?: Yes, both Medi-Cal fee-for-service and the county managed care plans. They are enrolled and worked separately, since a provider active with DHCS is not automatically loaded with every plan.
Our claims go through an IPA. Can you handle that?: Yes. Delegated arrangements are the norm in California. We route claims by the patient’s actual assignment rather than by the card, which is what stops the not-our-member denials.
Do you work with Kaiser?: For practices seeing Kaiser members under a contract or referral arrangement, yes. Kaiser’s structure means the claim path depends on the arrangement, so we confirm it before billing rather than assuming.
We are opening a second location in another county. What changes?: The Medi-Cal managed care plans change, and often the commercial contracts too. We handle it as a new payer set, including the enrollment work, rather than assuming the existing setup carries over.

Everywhere else

All billing services

Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

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