CALIFORNIA · MEDICAL BILLING & REVENUE CYCLE MANAGEMENT
Medical Billing Services in California
A California medical billing company that knows the statutes — and uses them to get you paid.
California gives providers more legal leverage than any other state: a 30-day pay-or-deny rule, 15 percent interest on late clean claims, and a formal dispute process for workers’ comp. Most billing companies don’t use any of it. BilNow builds California revenue cycle management around the rules that actually move money.
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CALIFORNIA AT A GLANCE
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BilNow is a New York-registered medical billing company serving practices across California, providing end-to-end revenue cycle management to California practices: eligibility, coding, claims, denials, A/R, payment posting, credentialing and reporting. Workflows are built for 27 county-organized Medi-Cal plans, the AB 3275 30-day pay-or-deny standard (effective January 1, 2026), Knox-Keene prompt-pay interest, and workers’ comp Independent Bill Review. Pricing is a percentage of collections from 2.7%, no setup fee.
KEY TAKEAWAYS
- Since January 1, 2026, California payers must pay or deny a complete claim within 30 calendar days (AB 3275).
- DMHC-regulated plans that miss clean-claim deadlines owe 15% annual interest under Health & Safety Code § 1371.35.
- Medi-Cal is organized by county across 27 managed care plans; beneficiaries have only 60 days to appeal.
- Workers’ comp disputes must go to Independent Bill Review within 90 days of the EOR — or they end.
REVIEWED FOR ACCURACY BY
Harris Mahmood — Director of RCM and Credentialing Operations, BilNow
Revenue cycle and credentialing operations lead. LinkedIn. Last reviewed: 17 September 2026. State regulatory facts on this page cite public agency and payer documentation.
Why Medical Billing in California Is a Legal Discipline as Much as a Clerical One
The state wrote the rules in your favor. Most billers never invoke them.
Medi-Cal covers more than 14 million Californians, most through managed care plans organized by county — L.A. Care, Health Net, Molina, CalOptima, Inland Empire Health Plan, Anthem Blue Cross and others — each with its own authorization rules and filing windows. The commercial market runs on Kaiser’s closed network alongside Anthem, Blue Shield of California and UnitedHealthcare. On top of that, California statute sets payment deadlines, interest penalties and dispute mechanisms that a billing partner can actually enforce.
AB 3275: 30 days to pay or deny
Effective January 1, 2026, Assembly Bill 3275 requires California insurers and health plans to pay or deny a complete claim within 30 calendar days, and any complaint about a late or denied payment must be treated as a formal grievance. Under the Knox-Keene Act, DMHC-regulated plans that miss clean-claim deadlines owe 15 percent annual interest under Health & Safety Code § 1371.35. BilNow tracks clean-claim dates and escalates stalled payments with the statute in hand.
Medi-Cal: 6-month filing, 60-day appeals
Medi-Cal fee-for-service claims must be received within six months following the month of service, and beneficiaries have only 60 days to appeal a denial — a third of the commercial window. Each of the 27 managed care plans layers its own deadlines on top. BilNow builds county-specific follow-up around the plan a patient is actually assigned to.
Workers’ comp and Independent Bill Review
California runs the largest workers’ compensation system in the US under the Division of Workers’ Compensation. Bills follow the Official Medical Fee Schedule, insurers have 45 working days to pay a complete bill, and payment disputes must go to Independent Bill Review within 90 calendar days of the Explanation of Review. Miss that window and the dispute is over. BilNow supports workers’ comp alongside commercial and Medi-Cal work with the IBR clock tracked per bill.
AB 72 and CMIA
California’s AB 72 surprise-billing protections predate the federal No Surprises Act and add a state dispute path for out-of-network providers at in-network facilities. The Confidentiality of Medical Information Act imposes stricter patient-data rules than HIPAA. BilNow’s workflows operate under both.
Sources: DHCS — Medi-Cal managed care · DMHC — Knox-Keene prompt pay · DIR — Division of Workers’ Compensation (IBR). Verify current rules with the payer before relying on any deadline.
WHAT CHANGED IN 2026
AB 3275 took effect January 1, 2026, moving commercial insurers to the same 30-day pay-or-deny standard already used by Medi-Cal and Original Medicare, and requiring late-payment complaints to be handled as formal grievances. Practices that were not tracking clean-claim dates precisely now have a statutory basis to recover interest on stalled payments — if their billing partner is tracking them.
A Billing Partner That Reads the Statute
Not just the EOB.
In most states, a slow payer is a nuisance. In California, a slow payer owes you interest — but only if someone is tracking the clean-claim date, filing the grievance, and citing the code section. BilNow connects the front desk to final payment with a team that treats California’s prompt-pay and dispute rules as tools, not trivia.
One team. One connected revenue cycle. Eligibility through A/R, with AB 3275 deadlines, Knox-Keene interest and IBR windows tracked per claim.
Full-Service Medical Billing for California Providers
Nine services, each built with California’s payment rules inside.
Experienced billers and coders, inside your EHR, with Medi-Cal county routing, AB 3275 clocks, and workers’ comp OMFS and IBR built into the workflow.
Coverage and benefits verified before the visit, including the patient’s specific Medi-Cal plan and county, Kaiser network status, and whether the encounter is a workers’ comp claim with its own payer and fee schedule.
ICD-10-CM, CPT and HCPCS by experienced coders in specialty workflows — and OMFS-compliant coding for workers’ comp bills, where a coding error resets the payer’s 45-day clock.
Claims validated and submitted to the correct Medi-Cal plan, commercial payer or workers’ comp carrier in the expected format, with the clean-claim date recorded — because under AB 3275, that date starts the payer’s 30-day obligation.
Root cause identified, corrected and resubmitted — and when a DMHC-regulated plan is late on a clean claim, the grievance is filed and 15% interest is requested under § 1371.35.
Balances prioritized by age, payer and statutory leverage. Late commercial claims escalated with interest demands; workers’ comp underpayments sent to Independent Bill Review inside the 90-day window.
ERA/EOB and patient payments posted and reconciled; workers’ comp Explanations of Review logged with their IBR deadline; interest payments tracked separately.
Statements, reminders and online payment — compliant with CMIA’s stricter privacy rules and AB 72’s surprise-billing limits.
Auth checks and requests across Medi-Cal plans and commercial carriers, with status tracking so a missing auth doesn’t become a denial.
Enrollment with Medi-Cal and each managed care plan, Medicare, commercial payers and workers’ comp MPNs; CAQH; recredentialing and tracking.
Medi-Cal and Workers’ Compensation Billing in California
Two payer systems with hard deadlines that end your claim if missed.
Medi-Cal Billing Support
County plan routing, 6-month filing, 60-day appeals
BilNow organizes eligibility, authorization, claims, posting, denials and A/R around the member’s actual county plan and its deadlines — not a single Medi-Cal payer ID.
Workers’ Compensation Billing
OMFS, 45 working days, 90-day IBR window
BilNow bills under the Official Medical Fee Schedule, tracks the insurer’s 45-working-day payment obligation, logs each Explanation of Review, and files Independent Bill Review before the 90-day deadline closes the dispute.
How to Choose a Medical Billing Company in California
Six questions that reveal whether a billing company actually uses California law.
Every vendor claims compliance. These questions show whether they enforce it.
QUESTION 1
Do you file grievances and request interest under AB 3275 and § 1371.35?
If they don’t know what those are, they’re leaving statutory interest on the table.
QUESTION 2
How do you track Independent Bill Review deadlines?
Ask what happens on day 85 after an EOR. The right answer involves a filed IBR, not a phone call.
QUESTION 3
Which Medi-Cal plans and counties have you billed?
L.A. Care, Health Net, CalOptima and IEHP have different rules. A national template doesn’t know that.
QUESTION 4
Who exactly works my account?
Names and credentials. Statutory knowledge doesn’t survive rotating reps.
QUESTION 5
Can I keep my EHR?
A vendor that forces migration is optimizing for their workflow, not yours.
QUESTION 6
How is pricing structured?
Percentage of collections aligns incentives. Setup fees and per-claim add-ons don’t.
BilNow vs. a Typical Billing Vendor
What California practices actually get — side by side.
| What matters | BilNow | Typical vendor |
|---|---|---|
| California payer rules | Workflows built per payer and program, with state deadlines tracked | One national template |
| Who works your account | A named team — billers, coders, an RCM lead, a billing manager | Rotating reps |
| Your EHR | You keep it; we work inside it | Migration to their system |
| Reporting | Claims, denials, A/R, DSO and filing risk, visible any time | A monthly PDF |
| Pricing | Percentage of collections, no setup fee, no long-term contract | Setup fees, minimums, per-claim add-ons |
| Content you’re reading | Reviewed by a named operations lead with a verifiable profile | Anonymous marketing copy |
Specialty-Specific Billing for California Practices
Specialty determines which California rules matter most.
Orthopedics and PT live in workers’ comp. Behavioral health lives in Medi-Cal county plans. Dermatology fights Kaiser out-of-network. BilNow builds the workflow around your specialty and your California payer mix.
Orthopedics
Workers’ comp OMFS, IBR disputes and MA surgical auths.
Physical Therapy
Workers’ comp visit limits, OMFS coding and Medi-Cal plan rules.
Pain Management
Injection auths across Medi-Cal plans and commercial carriers.
Behavioral Health
County Medi-Cal plan requirements and telehealth billing.
Dermatology
Cosmetic-vs-medical determinations and AB 72 out-of-network claims.
Urgent Care
High-volume multi-payer claims with 30-day prompt-pay tracking.
Also serving:
Don’t see your specialty? Ask our billing team →
Your EHR Stays. The Billing Gets Better.
No migration, no data risk, no retraining.
BilNow works inside the EHR and practice-management system you already run — important in California, where CMIA makes data handling stricter than HIPAA.
Reporting That Shows Your Statutory Leverage
Not just what’s owed — what’s late and what it costs the payer.
Clean-claim aging against the 30-day AB 3275 clock, interest accrued on late DMHC-plan payments, IBR deadlines by bill, and Medi-Cal appeal windows — alongside the usual claims, denials, A/R and DSO.
Days since clean claim, per payer
Late DMHC-plan payments at 15%
Workers’ comp bills by days remaining
60-day windows by claim
Reasons and repeat payers
Aging by payer and county plan
Posting and reconciliation
Cash-flow trend
California Medical Billing Glossary
Terms you’ll see on EOBs, portals and payer letters in California.
- AB 3275
- California law effective January 1, 2026 requiring insurers and health plans to pay or deny complete claims within 30 calendar days and treat late-payment complaints as grievances.
- Knox-Keene Act
- The California statute regulating HMOs and managed care plans under DMHC; § 1371.35 imposes 15% annual interest on late clean-claim payments.
- DMHC
- Department of Managed Health Care — regulates most California HMOs and enforces prompt-pay rules.
- Medi-Cal
- California’s Medicaid program, administered by DHCS; most members are in one of 27 county-organized managed care plans.
- Independent Bill Review (IBR)
- The DWC process for disputing workers’ comp payment amounts; must be requested within 90 days of the Explanation of Review.
- OMFS
- Official Medical Fee Schedule — the workers’ comp reimbursement schedule set by the Division of Workers’ Compensation.
A Named Team That Knows California’s Rules
You should know who is working your claims — and what they know.
Billing specialists, experienced coders, RCM oversight and a billing manager who can cite the code section when a payer is late.
How the Transition Works
From your current billing setup to BilNow, without disruption.
Specialty, providers, payer mix, county plans, EHR, workers’ comp volume.
Prompt-pay exposure, IBR windows, Medi-Cal appeals, aged A/R.
Routing and deadline tracking for your specific plans and carriers.
Inside your existing EHR and PM, CMIA-compliant.
The services in your engagement, run by a named team.
Claims, denials, A/R, interest and deadlines, any time.
Late payers escalated; repeat denials turned into fixes.
Serving Healthcare Providers Across California
Los Angeles to the Bay Area to the Central Valley.
BilNow supports practices throughout California, including:
Different county, different Medi-Cal plan. Same statutes, same team.
California Medicare Contractor and Payer Checklist
California Medicare Part B claims are processed by one contractor that also covers Nevada and Hawaii, while Medi-Cal, health plan and workers’ compensation claims each follow their own rules. The Medicare facts below link to the CMS page they come from; payer-specific deadlines are tracked separately.
| Medicare MAC (Part A and B) | Noridian Healthcare Solutions, LLC, A/B MAC Jurisdiction E (JE), which covers California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. Source: CMS, A/B MAC Jurisdiction E. |
|---|---|
| Jurisdiction scale | CMS reports Jurisdiction E serves approximately 3.9 million beneficiaries and about 436 Medicare hospitals, and handles about 11.2% of the national Part A and Part B claims workload. Source: CMS, A/B MAC Jurisdiction E. |
| Where to check other California deadlines | Medi-Cal, commercial health plan and workers’ compensation windows differ by payer. Look them up on our timely filing limits page and confirm with each plan’s provider manual. |
A single Noridian workflow for Medicare claims keeps California practices consistent while the state-regulated payers are handled on their own timelines. Deadlines for other payers are tracked on our timely filing limits page. Last checked against the cited sources on 3 October 2026; always confirm current rules with the payer.
Related: medical billing · medical coding · credentialing · denial management · A/R recovery · prior authorization · pricing · timely filing limits by payer · denial code lookup · Texas billing · New York billing · dermatology billing · mental health billing services.
$334,420 in aged A/R recovered across five practices.
Frequently Asked Questions
Do you work with Medi-Cal managed care plans?
Yes. BilNow bills Medi-Cal through county-organized plans including L.A. Care, Health Net, Molina, CalOptima and Inland Empire Health Plan, routing by the member’s actual plan and tracking the 6-month filing and 60-day appeal windows.
How does AB 3275 affect my practice?
Since January 1, 2026, California payers must pay or deny complete claims within 30 calendar days. BilNow records clean-claim dates, escalates late payments as formal grievances, and requests statutory interest where the law allows.
Can you handle California workers’ compensation billing?
Yes. BilNow bills under the Official Medical Fee Schedule, tracks the 45-working-day payer window, and files Independent Bill Review within 90 days of the EOR when payment is disputed.
What is Knox-Keene interest?
DMHC-regulated plans that fail to pay clean claims on time owe 15% annual interest under Health & Safety Code § 1371.35. BilNow tracks and requests it.
Do you handle Kaiser and out-of-network claims?
Yes. Kaiser’s closed network and AB 72’s surprise-billing rules create specific out-of-network workflows, which BilNow manages.
Can BilNow work inside our existing EHR?
Yes. athenahealth, eClinicalWorks, AdvancedMD, Kareo (Tebra), NextGen and many others, with CMIA-compliant data handling.
Do you provide credentialing with California payers?
Yes — Medi-Cal and each managed care plan, Medicare, commercial payers and workers’ comp MPNs, plus CAQH and recredentialing.
Does BilNow serve practices in California?
Yes. BilNow serves practices across California, with billing support across the state.
How much does medical billing cost in California?
Pricing depends on specialty, provider count, claim volume and services. BilNow offers a transparent percentage-of-collections model starting at 2.7% for qualifying practices, with no setup fee.
How do I get started?
Request a free revenue review or a conversation about your practice. We’ll show you what payers owe you under California law and what working with BilNow looks like.
Which Medicare Administrative Contractor processes Medicare claims in California?
Noridian Healthcare Solutions, LLC is the A/B MAC for Jurisdiction E, which includes California, according to CMS. BilNow submits California Medicare Part B claims to Noridian and follows them through remittance.
How does BilNow price medical billing in California?
BilNow charges 2.7% of collections, with no setup fee and no long-term contract. The pricing page explains how it works.
Where is BilNow based, and does it serve California?
BilNow is headquartered at 430 Fifth Avenue, New York, NY 10018, and serves California practices, including those in Los Angeles, San Francisco, San Diego, Sacramento and San Jose.
Where can I check California payer filing deadlines?
Use the timely filing limits page for payer deadlines and the denial code lookup to decode a denial. BilNow also works denials through denial management.
Ready to Use California Law to Get Paid Faster?
The statutes are on your side. Your billing partner should be too.
Stop letting late payers keep your money interest-free and IBR windows close unnoticed. BilNow handles the work behind the revenue.