About 78% of Medicaid beneficiaries are enrolled in comprehensive managed care organizations, so most Medicaid claims are adjudicated by a commercial insurer with its own rules — not by the state. Practices that bill "Medicaid" as one payer are billing a dozen.
Claims for California providers are adjudicated by Noridian Healthcare Solutions (JE), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Medicare contractor
Noridian Healthcare Solutions (JE)
Medicaid program
Medi-Cal
Managed care
Predominantly commercial plans
Auto injuries
Tort state — health plan sequencing applies
What changes in California
Medicaid in California runs as Medi-Cal and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
California prohibits fee splitting generally while authorising percentage-based billing arrangements subject to conditions. Our own pricing in California is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.
What we do
- Bill the plan that actually adjudicates rather than the program on the card
- Track filing windows per plan, which are frequently shorter than commercial
- Verify eligibility every visit, because Medicaid coverage churns monthly
- Sequence Medicaid last, since it is the payer of last resort and enforces that
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your California aging and denial mix.
Scope
A written scope and price before any work starts.
Transition
No gap in submission during the handover.
Report
Six numbers monthly, segmented by payer.
Medicaid Billing in California — Frequently Asked Questions
Which Medicare contractor covers California?
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Noridian Healthcare Solutions (JE). That is who adjudicates your Medicare claims and who hears a redetermination.
Is California Medicaid managed care?
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Medi-Cal is delivered largely through commercial managed care plans, so the plan sets the filing window and the authorization rules, not the state.
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