Workers Compensation Billing in California

Noridian Healthcare Solutions (JE). That contractor adjudicates Medicare claims for California providers, publishes the local coverage determinations that bind you, and hears the first level of appeal. An argument that works with them works across every state they cover.

It runs as Medi-Cal, delivered largely through commercial managed care plans. So most California Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

California is a tort state for auto injuries, so standard coordination of benefits applies rather than an auto carrier taking first position. The injury still has to be identified at registration, because liability coverage may be primary for the related care.

California prohibits fee splitting generally while authorizing percentage-based billing arrangements subject to conditions. Our pricing in California is set accordingly, and it is confirmed in writing before any work begins. That describes what we charge; your own position is a question for your counsel rather than for us.

No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking California's rules against your actual claims: its Medicare contractor, its Medicaid structure, and its auto-injury sequencing.

bill against the applicable state fee schedule rather than your commercial rates, track authorization and reporting requirements specific to the jurisdiction, manage the documentation these carriers require and commercial payers do not, and the follow-up that goes with them. Comp claims are billed to the schedule that governs them and followed up on the timeline they actually run on.