Medical Billing Company in California

Mukesh MakwanaFounder & CEO · 8+ years hands-on in medical billing & RCM · Reviewed October 1, 2026

A medical billing company for a California practice has to work with two California rulebooks at once: Medi-Cal provider enrollment under the Welfare and Institutions Code, and the Knox-Keene claim payment rules in Health and Safety Code section 1371, which since January 1, 2026 require health care service plans to pay or contest a complete claim within 30 calendar days. Sterling Global Solution LLC bills for California practices remotely, from inside their own EHR and practice management system, with Medi-Cal and plan deadlines tracked on every claim.

California claim payment rules (Health and Safety Code 1371)

For health care service plans regulated under the Knox-Keene Act, section 1371 currently provides, in summary:

30 calendar days to pay: a plan must reimburse a complete claim, in state or out of state, as soon as practicable but no later than 30 calendar days after receiving it.
30 calendar days to contest or deny: if a claim is incomplete or not covered, the plan must notify the provider in writing within the same 30 calendar days. A contest notice must identify the contested portion by procedure or revenue code and the specific information needed; a denial notice must give the specific reasons.
Interest is automatic: a complete claim not paid within 30 calendar days accrues interest at 15 percent per annum from the first day after the deadline, and the plan must include that interest without the provider having to ask. A plan that fails to do so owes an additional fee on top of the interest.
Prior authorization protects the claim: a plan may not contest a claim that is consistent with the procedure or revenue codes and services approved by prior authorization, when appropriate documentation is included on the claim.
Reconsideration after information arrives: when a claim was properly contested for missing information, the plan has 30 calendar days after receiving that information to finish reconsidering it.

The prior authorization protection is the one practices underuse. If the claim matches the approved codes and the authorization documentation is attached, a contest on those grounds is not allowed.

Medi-Cal provider enrollment

Under Welfare and Institutions Code section 14043.26, an applicant not enrolled in Medi-Cal, a provider applying for continued enrollment when the state requires it, or a provider adding a new practice location must submit a complete application package. The statute then gives the Department of Health Care Services a defined timeline:

Within 180 days of receiving the package, the department must notify the applicant that provisional provider status is granted for 12 months, that the package is incomplete (identifying what is needed), that background checks or inspections are under way, or that the application is denied.
On the 181st day, if none of those notices has been given, the department must grant provisional provider status for up to 12 months.
Preferred provider consideration: applicants who request it and meet the statute's criteria are notified within 60 days and can receive preferred provisional provider status for up to 18 months.
Moving within the same county: an enrolled individual physician practice in good standing can continue enrollment at a new location in the same county by filing a change of location form.

For Medi-Cal managed care, federal rules (42 CFR 438.602(b)) require states to screen and enroll all network providers of their Medicaid managed care plans. In practice that means Medi-Cal enrollment as well as credentialing with each managed care plan you join.

Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.

30-Day Free Trial

What this means for a California practice

Count payment deadlines in calendar days now, not working days, for plans under section 1371.
Check that late payments arrive with interest included, and follow up when they do not.
Attach authorization documentation to claims for authorized services, so they cannot be contested on those grounds.
Submit complete Medi-Cal enrollment packages; an incomplete package restarts the conversation with the department.
File a new enrollment or change of location before seeing Medi-Cal patients at a new site.

Specialties we bill for California practices

We bill for California behavioral health practices, psychiatry, ABA providers, fertility clinics, cardiology, orthopedic, OB-GYN and primary care practices.

How Sterling Global Solution LLC works with California practices

Eligibility and authorizations are confirmed before each visit, and authorization details go on the claim. Claims are sent electronically the day they are coded, tracked against the 30 calendar day payment rule, and checked for interest when they are paid late. Contest notices are answered with exactly the information requested, so the 30 day reconsideration clock starts quickly. New providers are enrolled with Medi-Cal and credentialed with each plan; new billing clients get free credentialing for 3 insurance payers. Start with our 30-Day Free Trial.

Frequently asked questions

Do you provide medical billing services for California practices?

Yes. Sterling Global Solution LLC bills for California practices remotely, inside your existing systems, with Medi-Cal enrollment and Knox-Keene claim payment deadlines tracked on every claim.

How fast must California health plans pay a claim in 2026?

Under Health and Safety Code section 1371, a health care service plan must reimburse a complete claim no later than 30 calendar days after receiving it, or notify the provider in writing within 30 calendar days that it is contested or denied.

Do California health plans have to pay interest on late claims?

Yes. A complete claim not paid within 30 calendar days accrues interest at 15 percent per annum, and the plan must include the interest automatically without the provider asking.

How long does Medi-Cal enrollment take?

Under Welfare and Institutions Code section 14043.26, the Department of Health Care Services must respond within 180 days of receiving a complete application package; if it does not, it must grant provisional provider status on the 181st day.

Can a California health plan contest a claim that was prior authorized?

Not on the grounds of the authorized services. Section 1371 says a plan may not contest a claim consistent with the procedure or revenue codes and services approved by prior authorization, with appropriate documentation included on the claim.

Sources

California Health and Safety Code, section 1371: 30 calendar day payment and contest deadlines, notice contents, 15 percent interest, prior authorization protection and reconsideration.
California Welfare and Institutions Code, section 14043.26: Medi-Cal application packages, 180-day response, provisional and preferred provisional status, change of location.
Code of Federal Regulations, 42 CFR 438.602(b): state enrollment of managed care network providers.

Statutes as published by California Legislative Information on the review date above; not legal advice. Insurers regulated by the Department of Insurance follow separate rules. How we verify this guidance.

Medical Billing Company for California Practices