Significant no-fault and personal injury exposure, which puts the auto carrier ahead of the health plan in states that run PIP. In California that plays out against a specific set of rules rather than a general one.
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
Coding driver
Active treatment versus maintenance care — the distinction every review examines and the record has to make.
Medicare contractor
Noridian Healthcare Solutions (JE)
Medicaid program
Medi-Cal
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.
Where chiropractic claims fail
- Care characterized as maintenance rather than active treatment
- Missing initial evaluation supporting necessity
- Auto claims billed to the health plan first
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 chiropractic denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Chiropractic Billing in California — Frequently Asked Questions
Do chiropractic billing rules differ in California?
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Medi-Cal is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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