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California Medical Billing: Medicare, Medicaid, and Auto Injury Claims

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Full transcript

Overview

For California practices, billing work starts with knowing which payer path each claim belongs to.

Medicare contractor

Medicare claims are handled by Noridian Healthcare Solutions JE, and that contractor hears the first level of Medicare appeal.

Medicaid program

Medicaid runs as Medi-Cal, delivered largely through commercial managed care plans, so many Medicaid claims go to a health plan rather than directly to the state.

Auto injuries

California is a tort state for auto injuries, so standard coordination of benefits applies rather than a no-fault carrier taking first position.

Coverage and pricing

Local coverage determinations can also affect whether the same service is covered in California but handled differently in another state.

Coding, claims, and follow-up

These details shape coding, charge entry, claim scrubbing, denial management, payment posting, Accounts receivable follow-up, coordination of benefits, patient billing, and support.

The takeaway

For California practices, the goal is to keep documents clean, payer sequencing clear, and claim follow-up moving without avoidable delays

1:03 7 chapters 144 words

What is different about billing in California?

Medicare contractor
Noridian Healthcare Solutions (JE)
Medicaid program
Medi-Cal
Medicaid delivery
Commercial managed care plans
Auto injuries
Tort: standard coordination of benefits
Read the California medical billing guide and rate card

Want your California claims worked for you?

We code, submit, and follow up on claims for California practices, with Medicare appeals worked to Noridian (JE) and Medicaid billed to Medi-Cal. Tell us about your practice and we'll send a written scope and price.

More state videos

Also for California practices

White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.

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