MedStats Billing delivers end-to-end revenue cycle management built for California practices. We bill across all five Medi-Cal managed care models, hold payers to the new 30-calendar-day prompt pay standard that took effect under AB 3275 on January 1, 2026, and manage DWC workers’ compensation billing from OMFS pricing through Second Bill Review and Independent Bill Review across the Golden State.
California is the most structurally complex billing environment in the country. Medi-Cal covers close to fourteen million residents through five different managed care models spread across all 58 counties, so the plans a practice can contract with depend entirely on which county it sits in. On the commercial side, a payer’s payment deadline depends on whether it is regulated by the Department of Managed Health Care or the Department of Insurance. And as of January 1, 2026, the prompt pay clock itself changed.
California Billing Specializations:
California Prompt Pay — AB 3275 (Health & Safety Code §§ 1371 and 1371.35, effective January 1, 2026) — Knox-Keene plans must now pay or contest a complete claim within 30 calendar days, replacing the previous 30 or 45 working-day standard. Interest accrues at 15% per annum from day 31 and plans must include it automatically. We track every submission against the new clock.
Medi-Cal Managed Care Across All Five Models — Two-Plan, County Organized Health Systems, Geographic Managed Care, Regional and Single Plan counties each work differently. We contract and bill according to the model that actually governs your county rather than applying one statewide process.
COHS County Billing — In County Organized Health System counties a single county-run plan is the only option. Partnership HealthPlan, CalOptima Health, CenCal Health, Central California Alliance for Health, Gold Coast Health Plan and Health Plan of San Mateo together cover 22 counties, each with its own authorization rules.
DMHC and CDI — Two Regulators, Two Deadlines — Health plans fall under the Department of Managed Health Care; indemnity insurers fall under the Department of Insurance and Insurance Code § 10123.13. Knowing which applies determines both the payment deadline and where a complaint gets filed.
DWC Workers’ Compensation (Labor Code § 4603.2) — Bills priced to the Official Medical Fee Schedule and checked line by line against the Explanation of Review, with Second Bill Review filed inside 90 days and Independent Bill Review through Maximus inside 30 days of the final EOR.
Medi-Cal Rx and CalAIM Carve-Outs — Pharmacy runs outside the managed care plan through Medi-Cal Rx, while Enhanced Care Management and Community Supports under CalAIM carry their own billing pathways. Claims routed to the wrong entity are denied.
Major California Commercial Payers — Anthem Blue Cross of California, Blue Shield of California, Health Net, Kaiser Permanente, Molina Healthcare of California, L.A. Care and Sharp Health Plan denial workflows.
Built to bring clarity, control and consistency to your California practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for California providers — from Medi-Cal and commercial payer enrollment, through claim submission and denial resolution, to recovery of aged receivables and workers’ compensation underpayments.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceCalifornia practices lose revenue to problems created by the state’s own structure — county-by-county plan models, split regulators, and a prompt pay rule that changed this year. These are the four we eliminate:
In County Organized Health System counties a single county-run plan is the only route to Medi-Cal patients. Practices that treat contracting as optional, or apply another county's workflow, simply cannot bill those encounters.
AB 3275 shortened the deadline to 30 calendar days on January 1, 2026 and entitles providers to 15% annual interest past it. Practices still tracking the old working-day standard are measuring against a clock that no longer exists.
OMFS miscalculation is routine, and a Second Bill Review not filed within 90 days of the EOR permanently satisfies the bill. No further payment can be claimed from the employer or the employee.
A Knox-Keene plan and an indemnity insurer answer to different agencies under different statutes and different timelines. Pursuing a late claim under the wrong one wastes the window entirely.
Effective January 1, 2026, a complete claim must be reimbursed within 30 calendar days of receipt, and any contest or denial issued in the same window. We track submission and adjudication dates against the new standard on every claim.
Claims unpaid past 30 calendar days accrue interest at 15% per annum from day 31, and plans are required to include it without being asked. Where they do not, they also owe the greater of $15 or 10% of the accrued interest. Our AR team pursues both.
Two-Plan, COHS, Geographic Managed Care, Regional and Single Plan counties each determine which plans you can contract with. We enroll and bill by county model, and handle the Medi-Cal Rx pharmacy carve-out separately.
Claims administrators must pay or object within 45 days. We price to OMFS, audit the Explanation of Review for underpayment, file Second Bill Review inside 90 days, and escalate to Independent Bill Review through Maximus inside 30 days.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles Medi-Cal enrollment by county model, commercial credentialing, clean claims processing, prompt-pay enforcement and workers’ compensation appeals across California, giving practices end-to-end RCM support in the most complex payer environment in the country.
Claims are scrubbed against Medi-Cal managed care plan and commercial payer edits before submission to drive clean first-pass reimbursement.
Rejected claims are audited immediately, appealed with complete clinical documentation, and tracked until they are paid.
Monthly reporting on collections, AR aging and denial trends keeps you fully informed on the health of your revenue cycle.
Working knowledge of Anthem Blue Cross of California, Blue Shield of California, Health Net, Kaiser Permanente, Molina and L.A. Care submission protocols.
Whether you practice in Los Angeles, San Diego, the Bay Area or the Central Valley, our workflows adjust seamlessly as your group grows.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, confirm compliance with the new 30-day prompt pay standard, and recover workers’ compensation underpayments still inside their appeal window.
Under Health & Safety Code § 1371 as amended by AB 3275, effective January 1, 2026, a complete claim must be reimbursed within 30 calendar days of receipt. Claims unpaid past that point accrue interest at 15% per annum from day 31, and plans must include that interest automatically without a provider request.
Before 2026, HMOs had 45 working days to pay a claim and other Knox-Keene plans had 30 working days. From January 1, 2026 every plan must pay or contest a complete claim within 30 calendar days. Moving from working days to calendar days advances every deadline substantially.
Five: Two-Plan, County Organized Health Systems, Geographic Managed Care, Regional and Single Plan. They operate across all 58 counties, and the model in place determines which plans a practice can contract with, so enrollment strategy differs county by county.
In a County Organized Health System county, DHCS contracts with a single county-run plan and members have no choice of plan. Six COHS plans cover 22 counties: Partnership HealthPlan, CalOptima Health, CenCal Health, Central California Alliance for Health, Gold Coast Health Plan and Health Plan of San Mateo.
Bills are priced to the Official Medical Fee Schedule and audited line by line against the Explanation of Review. Underpayments go to Second Bill Review within 90 days of the EOR, then to Independent Bill Review through Maximus within 30 days of the final EOR. Missing the 90-day window satisfies the bill permanently.
No. California is an at-fault state with no personal injury protection requirement. We bill any available MedPay, coordinate with the patient’s health plan, and manage liens and third-party liability claims so treatment is not written off while liability is resolved.
We serve practices and healthcare facilities statewide, including Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, Long Beach, Oakland, Bakersfield, Anaheim and Riverside.
