Medical billing services in California

Medi-Cal is run by the California Department of Health Care Services (DHCS). Provider enrollment goes through PAVE (Provider Application and Validation for Enrollment)², at pave.dhcs.ca.gov, and fee-for-service claims go through the Medi-Cal Provider Portal¹⁴, at medi-cal.ca.gov. About 96 percent of Medi-Cal enrollees (14.3 million of 14.9 million in 2024) were enrolled in full-benefit managed care plans³. CMS managed care enrollment data for 2024. Plans are assigned by county model (County Organized Health System, Two-Plan, Geographic Managed Care, Regional and Single-Plan); the list below groups them by plan.

Fee-for-service filing limit: Six months following the month of service for original fee-for-service claims (Welfare and Institutions Code Section 14115; 22 CCR Section 51008), with four statutory exceptions that allow later billing⁵. Late claims without an allowed exception pay 75 percent of the payable amount in months 7 to 9, 50 percent in months 10 to 12, and nothing after month 12; a claim that uses an exception carries a delay reason code and its documentation. Medi-Cal managed care plans apply the six-month limit, but each plan sets its own counting and cutoff in its claims policy (San Francisco Health Plan denies claims submitted more than one year after the month following the date of service), so each plan's provider manual is checked.

Managed care plans⁴

• L.A. Care Health PlanTwo-Plan model, Los Angeles; the largest single plan by enrollment in the CMS list
• Health Net Community SolutionsTwo-Plan model in Los Angeles, San Joaquin, Stanislaus and Tulare; Geographic Managed Care in Sacramento; Regional model
• Anthem Blue Cross Partnership PlanTwo-Plan model in Fresno, Kern, Kings, Madera, San Francisco, Santa Clara, Tulare and others; Geographic Managed Care in Sacramento; Regional model
• Kaiser PermanenteOffered across County Organized Health System, Two-Plan, Geographic Managed Care, Regional and Single-Plan counties
• Molina Healthcare of California Partner PlanGeographic Managed Care in Sacramento and San Diego; Two-Plan model in Riverside and San Bernardino
• Blue Shield of California Promise Health PlanGeographic Managed Care, San Diego
• Community Health GroupGeographic Managed Care, San Diego
• Inland Empire Health PlanTwo-Plan model, Riverside and San Bernardino
• CalViva HealthTwo-Plan model, Fresno, Kings and Madera
• Health Plan of San Joaquin / Mountain Valley Health PlanTwo-Plan model, San Joaquin and Stanislaus; Mountain Valley in Alpine and El Dorado
• Kern Family Health CareTwo-Plan model, Kern
• San Francisco Health PlanTwo-Plan model, San Francisco
• Santa Clara Family Health PlanTwo-Plan model, Santa Clara
• CalOptimaCounty Organized Health System, Orange
• CenCal HealthCounty Organized Health System, Santa Barbara and San Luis Obispo
• Central California Alliance for HealthCounty Organized Health System, Santa Cruz, Monterey, Merced, San Benito and Mariposa
• Gold Coast Health PlanCounty Organized Health System, Ventura
• Health Plan of San MateoCounty Organized Health System, San Mateo
• Partnership HealthPlan of CaliforniaCounty Organized Health System across its northern regions
• Alameda Alliance for HealthSingle-Plan model, Alameda
• Contra Costa Health PlanSingle-Plan model, Contra Costa
• Community Health Plan of Imperial ValleySingle-Plan model, Imperial

Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins California Medicaid through one plan is not in network with the others until each contract is in place.

Commercial payers active in California⁷: Anthem Blue Cross, Blue Shield of California, Kaiser Permanente, Health Net of California, UnitedHealthcare, Sharp Health Plan, Western Health Advantage, Sutter Health Plan. Each has its own filing window, corrected-claim process and appeal levels in its provider manual, and the timely filing limits table lists verified payer deadlines with their sources.

Clean-claim payment window under AB 3275 (Statutes of 2024), implemented through DMHC All Plan Letter 25-007: 30 calendar days to pay or deny a complete claim, from January 1, 2026⁶. Replaces the earlier 45 working day standard for HMOs. Interest on an uncontested claim paid late accrues at 15 percent per year from the day after the 30-day period, and a plan that does not pay the interest within 5 working days of the claim payment owes an added $15 or 10 percent of the accrued interest. For a California practice, the statute does its work in A/R follow-up: a clean claim still unpaid after the window is escalated with the statute cited, and interest is requested where the law provides it.