California has more physicians than any other state and one of the most complex healthcare regulatory environments in the country. Between Medi-Cal’s managed care system, the state’s aggressive balance billing laws (AB 72), Knox-Keene Act requirements, and a commercial payer landscape dominated by Kaiser, BCBS, Anthem, and Health Net, California billing requires specific expertise. Go Medical Billing works with California practices across the state.
Medi-Cal Managed Care
California’s Medicaid program (Medi-Cal) covers over 15 million residents through a managed care system that varies by county. Plans include LA Care, Health Net, Molina, Anthem Blue Cross, CalOptima, and dozens of county organized health systems. Each plan has its own provider enrollment process, fee schedules, and claims rules. We handle Medi-Cal billing across all plans and counties.
Knox-Keene Act and AB 72
California’s balance billing protections go further than federal law. AB 72 prohibits balance billing for non emergency services at in network facilities. The Knox-Keene Act regulates managed care plans differently than in other states. Our team ensures your billing practices comply with California’s specific regulatory framework.
Kaiser and Capitated Plans
California has the highest penetration of HMO and capitated plans in the country. Billing for services rendered to patients covered under capitated arrangements requires understanding which services are carved out, which require authorization, and how to correctly bill the responsible party. We navigate this daily.
High Cost of In House Billing
California’s minimum wage and cost of living make in house billing staff extremely expensive. A medical biller in Los Angeles or San Francisco costs $50,000 to $70,000 annually before benefits. Outsourcing at 2.49% is a significant cost reduction.
Cardiology, urology, urgent care, behavioral health, orthopedics, ABA therapy, DME, laboratory, internal medicine, dermatology, pain management, OB/GYN, and more. We serve practices from San Diego to Sacramento and everywhere in between.
Do you handle Medi-Cal billing?
Yes. We bill all Medi-Cal managed care plans across every California county. We also handle Medi-Cal fee for service claims where applicable.
Can you credential providers with California plans?
Yes. We manage credentialing with Medi-Cal managed care plans, Medicare (Noridian), and all commercial payers operating in California.
How does your pricing compare to California billing staff costs?
At 2.49% of collections, our rate is typically 60 to 75% less than the fully loaded cost of an in house biller in California, and you get an entire team instead of one employee.
Call 888 701 6090 for a free California billing assessment.
