Medical Billing Services in California
Billing, coding, credentialing and denial management for California practices, with Medicare claims through Noridian Healthcare Solutions (Jurisdiction JE) and California Medicaid handled by people who know the rules.
Medical billing for California practices
California is the largest and most complex billing market in the country. Medi-Cal covers a large share of the state, mostly through county-based managed care plans, Medicare Part B runs through Noridian in Jurisdiction E, and many HMO patients are managed by delegated IPAs and medical groups that pay claims themselves. Starting January 1, 2026, AB 3275 set a 30 calendar day deadline for health care service plans to pay, contest or deny claims.
Practices in Los Angeles, the Bay Area, the Central Valley and San Diego each face a different mix of local Medi-Cal plans and commercial HMOs. SFA Solutions works with practices across California remotely. We bill inside your existing EHR, route each claim to the correct plan or IPA, submit most clean claims within 24 hours and work denials through appeal.
California at a glance
| Medicare contractor | Noridian Healthcare Solutions, Jurisdiction JE |
|---|---|
| Medicaid timely filing | Fee-for-service: within 6 months after the month of service for full payment; claims filed in months 7 to 9 are reduced 25% and months 10 to 12 are reduced 50% unless an exception applies (Welf. & Inst. Code 14115). Managed care plans set their own limits. |
| NP practice authority | Restricted |
| Cities we serve | Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, Long Beach, Oakland, Bakersfield, Riverside |
What California billing involves
These are the programs and rules our team works with for California claims.
Medicare
Noridian Healthcare Solutions · JECalifornia Part B claims are processed by Noridian Healthcare Solutions in Jurisdiction JE. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
California Medicaid
Medi-Cal (California Department of Health Care Services)
Portal: Provider Application and Validation for Enrollment (PAVE) portal for enrollment; Medi-Cal Provider Portal at medi-cal.ca.gov for fee-for-service claims
Medicaid managed care
Most Medi-Cal members are in managed care plans assigned by county, including local plans such as L.A. Care, Inland Empire Health Plan and CalOptima Health and commercial plans such as Health Net, Anthem Blue Cross, Molina Healthcare and Kaiser Permanente. Many plans delegate claims payment to IPAs and medical groups.
Timely filing
Fee-for-service: within 6 months after the month of service for full payment; claims filed in months 7 to 9 are reduced 25% and months 10 to 12 are reduced 50% unless an exception applies (Welf. & Inst. Code 14115). Managed care plans set their own limits..
Commercial and Medicare Advantage
Kaiser Permanente, Blue Shield of California, Anthem Blue Cross, Health Net, UnitedHealthcare, Aetna and Cigna are the largest commercial payers. Medicare Advantage is common, often through delegated medical groups.
Prompt pay law
Under AB 3275, for claims received on or after January 1, 2026, health care service plans regulated by the Department of Managed Health Care must pay, contest or deny a claim within 30 calendar days of receipt, replacing the earlier working day deadlines. Unpaid complete claims accrue interest at 15% per year after that period. Insurers regulated by the Department of Insurance follow separate Insurance Code timelines.
Nurse practitioners
Restricted practiceMost California NPs practice under standardized procedures with a supervising physician. Under AB 890, NPs can become 103 NPs after a transition to practice of three full-time years or 4,600 hours, and 104 NPs (practice outside a group setting) after three more full-time years or 4,600 hours as a 103 NP. The Board of Registered Nursing could not certify 104 NPs before 2026.
Credentialing
Medi-Cal enrollment runs through the PAVE portal, and each Medi-Cal managed care plan and delegated IPA credentials providers separately. Most commercial plans use CAQH ProView data. Medicare enrollment goes through PECOS with Noridian JE.
Billing challenges California practices face
Medi-Cal six month rule
Fee-for-service Medi-Cal claims must be filed within six months after the month of service for full payment. Late claims are cut by 25% or 50%, and after 12 months they are generally not payable. Fast submission and daily rejection review protect the full rate.
Delegated IPAs and medical groups
Many California HMO and Medi-Cal members are assigned to an IPA or medical group that pays claims on behalf of the plan. Sending a claim to the health plan instead of the delegated group causes denials and delays. Checking the member's assigned group at intake avoids this.
New 2026 payment deadlines
AB 3275 moved health care service plans to a 30 calendar day payment, contest or denial deadline starting January 1, 2026. Practices that track payment dates can hold plans to that timeline and check that the required interest is paid. Without that tracking, late payments go unnoticed.
Our services in California
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in California
California medical billing questions
What is the timely filing limit for Medi-Cal?
Fee-for-service Medi-Cal claims should be submitted within six months after the month of service for full payment. Claims filed in months 7 to 9 are reduced 25% and claims filed in months 10 to 12 are reduced 50%, unless an exception applies. Medi-Cal managed care plans set their own limits.
How fast must California health plans pay claims in 2026?
AB 3275 took effect January 1, 2026, and requires health care service plans to pay, contest or deny a claim within 30 calendar days of receipt. Complete claims paid late accrue interest at 15% per year. Insurers regulated by the Department of Insurance follow their own Insurance Code deadlines, so we track each payer type separately.
Who is the Medicare contractor for California?
Noridian Healthcare Solutions processes Medicare Part B claims for California under Jurisdiction E, which also covers Hawaii and Nevada. Medicare enrollment changes go through PECOS.
Can nurse practitioners bill independently in California?
California NPs bill under their own NPI, but most practice under standardized procedures with physician supervision. AB 890 created 103 and 104 NP categories with more independence after required practice hours, and the Board of Registered Nursing began certifying 104 NPs in 2026.
Get a free billing audit for your California practice
We will review your recent claims and denials against California payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction E (JE)
- Welfare and Institutions Code 14115 (Medi-Cal claim timeliness)
- AB 3275 (2024) bill text
- DMHC APL 25-007, AB 3275 guidance on claim reimbursement
- California Board of Registered Nursing: Assembly Bill 890
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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