California has over 39 million residents. Medi-Cal is the largest Medicaid program in the country with more than 14 million members. Covered California serves more than 1.6 million enrollees.
Major commercial carriers include:
Revenue slips quietly. Then it takes months to fix.
We verify active Medi-Cal MCO assignment, Covered California plan tier, deductibles, copays, and prior authorization triggers before every visit. If a patient switched plans yesterday, we catch it today.
Certified coders assign ICD-10, CPT, and HCPCS codes while following payer-specific edits for Medi-Cal, Covered California, and commercial carriers. This prevents revenue loss from undercoding and avoids audit risk.
Every claim undergoes a payer-specific audit that checks modifiers, NPI linkages, authorization numbers, place of service, and clearinghouse routing. Our first-pass clean claim rate exceeds 98% for California clients.
We submit complete authorization packets 24–48 hours before procedures, track approvals, attach numbers correctly, and manage renewals for ongoing care.
All denials are reviewed within 48 hours. We identify the root cause, correct the claim, and submit appeals with proper documentation. Patterns are fixed at the source, not repeated across 200 claims.
We actively manage 30-, 60-, 90-, and 120+ day aging buckets, prioritizing high balances and claims nearing their timely filing deadlines. Most clients see measurable AR improvements within 60–90 days.
We manage commercial and Medi-Cal MCP enrollment, Covered California network credentialing, and recredentialing cycles. New providers start billing faster, with no silent enrollment gaps.
Every county, every MCO, every claim submitted right.
Medi-Cal runs through 24 MCOs across California. In Los Angeles County alone, members may be assigned to L.A. Care, Anthem Partnership Plan, Blue Shield Promise, Molina, or Health Net. Billing the wrong plan results in an instant denial. We verify MCO assignments for every encounter and submit claims through the appropriate channel, ensuring compliance with CalAIM billing requirements. Medi-Cal operates through 24 managed care plans across 58 counties. Each plan uses its own submission rules and authorization matrix.Billing the wrong plan results in immediate denial.We verify the MCO assignment before every encounter and submit it through the correct channel each time.
We also stay current with CalAIM billing requirements, including Community Supports and Enhanced Care Management services.
Managing billing in-house can leave revenue on the table. Annual MCO checks, delayed denial follow-ups, missed policy updates, and staff turnover all create gaps that affect cash flow. ANR eliminates these risks with a streamlined, payer-specific workflow that keeps claims moving, resolves denials quickly, and ensures revenue flows consistently.
MCO verification is checked once per year
Denials worked days later
Policy updates missed
Revenue drops during staff turnover
MCO verified before every visit
Denials worked within 48 hours
California payer updates are monitored continuously
No staffing gaps
Review denial rates, AR aging, clean claim percentage, and coding accuracy. Identify revenue leaks.
Epic, athenahealth, eClinicalWorks, Kareo, AdvancedMD, Greenway Health. Go live in 5-7 business days.
Fix enrollment issues before claims are submitted.
Daily claim processing begins immediately.
No backlog.
Clear metrics and actionable insights.
We integrate seamlessly with your billing system, EHR platform, and workflow. No retraining. No system rebuild. Just smooth, efficient billing tasks.
Platforms include:
Our billing team adapts to your existing workflow so your staff doesn’t experience disruption.
(860) 500-1471
ANR Medical Billing serves providers across every corner of California. No matter your location or practice size, our team brings local payer expertise and statewide reach straight to your office.
We serve providers across:
SERVING CONNECTICUT AND SURROUNDING COMMUNITIES
