Medical Billing Services in California
California practices bill Noridian for Medicare Part A and B, Medi-Cal and its managed care plans, and a commercial market shaped by HMOs and medical groups. We help keep those claims moving. We support practices in California remotely across 15+ specialties.
Who Pays Medical Claims in California
The payer groups our team works with every day for California practices.
Jurisdiction JE
California Medicare Part A and Part B claims go to Noridian Healthcare Solutions, LLC. Medicare DME claims go to DME MAC Jurisdiction D (Noridian Healthcare Solutions).
Medi-Cal
Run by the Department of Health Care Services (DHCS).
Managed care plans
Most Medi-Cal members are enrolled in Medi-Cal managed care plans, which handle authorization and claims for their members. Fee-for-service Medi-Cal uses the Treatment Authorization Request (TAR) process for services that need approval. We bill and follow up with the state’s Medicaid managed care plans under each plan’s own rules.
Plan lists change. We confirm each patient's current plan at eligibility check. Commercial and Medicare Advantage plans are billed under their own contracts.
California Medicaid Billing Rules to Know
Taken from the state program's published provider guidance. Manuals change, so we confirm current rules before each submission.
Six-month billing limit
Original fee-for-service Medi-Cal claims must be received within six months following the month of service to get full payment.
Reduced payment for late claims
Claims received after the six-month limit get reduced payment, and claims over 12 months are denied unless an approved delay reason code applies.
Follow-up deadlines
Claims Inquiry Forms (CIFs) must be filed within six months of the Remittance Advice Details (RAD) date, and appeals within 90 days of the RAD date.
Source: Medi-Cal Provider Manual: Claim Submission and Timeliness Overview; CMS-1500 Submission and Timeliness Instructions; Claim Submission & Follow-Up Overview (DHCS).
What Makes California Medical Billing Different
What we watch for on California accounts.
Why California billing gets complicated
Medi-Cal pays less the later a claim arrives, so delays cost money even before the hard deadline. Many California patients are in HMO plans or delegated medical groups, which means the claim and the authorization may go to the medical group rather than the health plan. Our prior authorization services send the request to the right group, not just the health plan.
What We Handle for California Practices
Take the full revenue cycle or just the parts you need help with.
Eligibility and benefits checks before the visit
Prior authorization requests and tracking
Medical coding and charge review
Claim submission to Medicare, Medicaid and commercial payers
Denial management, appeals and A/R follow-up
Payment posting, patient statements and monthly reporting
Specialties We Support in California
15+ specialties served. Pick yours to see how we bill it.
California Medical Billing Questions
Short answers to questions we hear from practices.
Who processes Medicare Part A and B claims in California?
California is in A/B MAC Jurisdiction E (JE), administered by Noridian Healthcare Solutions. Noridian also runs the Jurisdiction D DME MAC that covers California.
What is the Medi-Cal timely filing limit?
Original fee-for-service claims must be received within six months following the month of service for full payment. Later claims are paid at a reduced rate, and claims over 12 months are denied unless an approved delay reason applies.
What is a TAR?
A Treatment Authorization Request is how fee-for-service Medi-Cal approves services that need prior authorization. Medi-Cal managed care plans use their own authorization process.
Which specialties do you support in California?
We support 15+ specialties, including behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT.
Do you have an office in California?
No. We support practices in California remotely, with secure access to your billing system.
See Where Your California Claims Are Getting Stuck
Start with a free billing audit. We review your recent claims, denials and A/R, then tell you what we found.