Stars Pro provides expert medical billing services in California (CA), ensuring maximum reimbursements and minimized denials by staying current with Medi-Cal regulations, AB-72 billing laws, and evolving CPT coding standards. Our California-specific expertise helps practices reduce A/R days by 30% and increase collections by 20% through precise claims submission and denial recovery.
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We begin by collecting comprehensive patient demographics and insurance information, including primary and secondary coverage details. Our team conducts real-time eligibility checks through California-specific payer portals like Medi-Cal’s DHCS system to verify coverage and benefits. We proactively identify potential AB-72 surprise billing scenarios and out-of-network issues to prevent compliance violations before they occur.
Our specialists ensure all provider documentation meets California’s stringent requirements, including proper CPT coding (e.g., 99213, 90837) and accurate ICD-10 code linkage. Charges are entered into our system within 24 hours of service to maintain compliance with Medi-Cal’s 90-day filing deadline and other payer-specific submission windows.
Every claim undergoes rigorous scrubbing using AI-powered editing tools that check for CCI (Correct Coding Initiative) violations, LCD (Local Coverage Determination) requirements, and Medi-Cal’s unique TAR (Treatment Authorization Request) rules. We meticulously apply necessary modifiers (e.g., 95 for telehealth, 25 for significant E/M services) to prevent denials and ensure maximum reimbursement.
We submit clean claims electronically through California-preferred clearinghouses like Availity and Change Healthcare for fastest processing. For payers requiring paper claims (such as certain Workers’ Comp cases), we prepare and mail CMS-1500 forms with tracking to ensure timely receipt.
Our team accurately posts payments by matching EOBs (Explanation of Benefits) to original claims using automated California fee schedules. We conduct detailed reconciliation to identify and dispute underpayments, particularly for services reimbursed at different rates between Medicare and California commercial payers.
We analyze and resolve the most common California denials, including prior authorization issues, missing modifiers, and Medi-Cal TAR delays. Our appeals process follows payer-specific timelines, such as Blue Cross CA’s 180-day appeal window, to recover every dollar owed to your practice.
We generate AB-72-compliant patient statements that clearly outline financial responsibilities while adhering to California’s balance billing protections. For self-pay accounts, we implement California-friendly payment plans and financial assistance guidance to improve collections and reduce bad debt.
We provide customized reports tracking California-specific KPIs, including A/R days, denial rates segmented by payer (Medi-Cal vs. commercial), and reimbursement trends for telehealth versus in-person services. These insights help you make data-driven decisions to optimize revenue cycle performance.
Our credentialing specialists manage enrollment with Medi-Cal, Medicare CA, and major regional payers like Kaiser Permanente. We prevent credentialing gaps that can delay California provider onboarding by 60+ days, ensuring you can start seeing and billing for patients without unnecessary delays.