Medical Billing Services in California

California practices bill Medicare through Noridian, Medi-Cal through county-based managed care plans and a crowded commercial market that includes Blue Shield of California, Anthem Blue Cross and Health Net — often with an IPA or medical group sitting in the middle.

Medicare Part B contractorNoridian Healthcare Solutions — Jurisdiction E (JE)

Medicaid programMedi-Cal, run by the Department of Health Care Services (DHCS)

Medicaid managed careCounty-based Medi-Cal managed care plans

Major commercial payersBlue Shield of California, Anthem Blue Cross, Health Net, UnitedHealthcare and Aetna

How Medical Billing Works in California

Every state has its own mix of payers and rules, and California is no exception. These are the points that most often decide whether a California claim is paid on the first pass:

Medi-Cal managed care plans differ from county to county, so eligibility checks have to confirm both Medi-Cal coverage and the specific plan the patient is assigned to.
California is split into many Medicare payment localities, which means fee schedules — and expected payments — vary between Los Angeles, the Bay Area, San Diego and the Central Valley.
Many California patients are covered through delegated medical groups and IPAs, so we confirm who actually holds financial responsibility before a claim is sent.

Our Medical Billing Services in California

We run the complete revenue cycle for California practices, remotely and inside your existing EHR or practice management system:

Insurance eligibility and benefits verification before each visit
Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
Charge entry and claim scrubbing to catch errors before submission
Electronic claim submission to Medicare, Medi-Cal plans and commercial payers
Denial management and appeals with root-cause tracking
A/R follow-up on aging claims, worked daily
Payment posting from ERAs and EOBs, including underpayment checks
Credentialing and payer enrollment, including PAVE (Provider Application and Validation for Enrollment)
Monthly reporting on collections, denials and days in A/R

Who We Work With

Our California clients include primary care and internal medicine practices, specialty groups such as toxicology billing, neurology billing and rheumatology billing, independent laboratories and multi-location clinics. Whether you are in Los Angeles, San Diego or a smaller community, you get the same certified coders, the same daily A/R follow-up and the same transparent reporting.

Cities We Serve in California

Los AngelesMedical billing services San DiegoMedical billing services San JoseMedical billing services San FranciscoMedical billing services FresnoMedical billing services SacramentoMedical billing services Long BeachMedical billing services OaklandMedical billing services BakersfieldMedical billing services AnaheimMedical billing services

Specialties We Bill For in California

Neurology Cardiology Pathology Gastroenterology Laboratory Dental Physician Internal Medicine Toxicology Molecular Clinical Endocrinology Otolaryngology (ENT) Hematology Radiation Oncology Rheumatology

Frequently Asked Questions

Who processes Medicare claims in California?

Medicare Part B claims for California are processed by Noridian Healthcare Solutions (Jurisdiction E (JE)). We submit, track and follow up on those claims for you, including Medicare Advantage plans, which are billed to the private plan instead.

How do you bill Medi-Cal?

Medi-Cal is run by the Department of Health Care Services (DHCS), and most members are enrolled in county-based Medi-Cal managed care plans. We verify the member's plan before the visit and send each claim to the right plan with the right edits.

Which commercial payers do you work with in California?

We bill all major commercial payers in California, including Blue Shield of California, Anthem Blue Cross, Health Net, UnitedHealthcare and Aetna, plus regional and employer plans.

Which California cities do you serve?

We serve practices throughout California, with dedicated pages for Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, Long Beach, Oakland, Bakersfield and Anaheim. Because billing is done remotely, practices anywhere in the state can work with us.

How do we get started?

Request a free billing audit. We review a sample of your claims, denials and A/R, show you where revenue is being lost and give you a fixed quote — with no obligation.