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Revenue cycle management services
in California
Qualigenix runs the revenue cycle for independent California practices, from Medi-Cal eligibility and prior authorization to the posted payment and the patient balance. One team, every payer. HIPAA-compliant.
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How Qualigenix serves California practices
Qualigenix runs revenue cycles for independent practices in 48 states. California practices lose revenue at more handoffs than most, because the payer mix is wide and each payer type answers to a different state agency: the Department of Health Care Services for Medi-Cal, the Department of Managed Health Care for HMOs and the Department of Insurance for most PPOs. When eligibility, authorization, coding, billing and follow-up sit with different vendors or staff, a Medi-Cal eligibility lapse found at billing is already a lost visit. Qualigenix keeps those steps with one team, so a problem found at the back end goes straight to the step that caused it. Qualigenix works with all payers and inside your current EHR, one of 133 platforms we support. Practices that only need claims handled can start with medical billing and add the rest later.
What revenue cycle management services does Qualigenix provide in California?
Qualigenix's revenue cycle management services connect eight steps for California practices: insurance verification, prior authorization, coding, billing, payment posting, denial management, A/R recovery and credentialing.
The same team tracks Medi-Cal's monthly eligibility, California's prior authorization deadlines and the 30-day clean-claim payment rule that took effect in January 2026.
California revenue cycle problems we solve
California revenue leaks in four places: eligibility and authorization missed before the visit, claims filed past a payer's window, payments that arrive late or short and patient balances billed wrong. Qualigenix closes each one with a step owned by a named team member.
Eligibility and prior authorization checked before the visit
Medi-Cal eligibility is set month to month, so last month's check doesn't cover this month's visit. Qualigenix verifies each Medi-Cal patient for the month of service through the state's eligibility system. For authorizations, California law gives commercial plans five business days for standard requests and 72 hours for urgent ones. Since January 2026, Medi-Cal managed care and Medicare Advantage plans must decide standard requests within 7 calendar days. We track every request to its deadline through our prior authorization team.
Claims filed inside every payer's window
Each California payer runs a different filing clock. Medi-Cal wants the original claim within six months of the month of service and cuts payment by 25% or 50% after that. Commercial plans must allow at least 90 days for contracted providers and 180 days for non-contracted providers. Medicare claims go to Noridian within 12 months. Qualigenix sets the deadline for each claim the day the charge is entered, and claims near a deadline jump the queue.
Payments posted and tracked against California's payment deadlines
Since January 1, 2026, California health plans and insurers, Medi-Cal managed care plans included, must pay a clean claim or notify you of a denial within 30 calendar days. Health plans that pay late owe 15% a year in interest and must add it on their own. Qualigenix posts each payment against that 30-day clock and the contract rate, then chases missing interest and underpayments through A/R recovery.
Patient balances billed correctly
California shields patients from surprise bills when an out-of-network provider treats them at an in-network facility for non-emergency care. They owe only the in-network cost share. Qualigenix checks network status and the payer's patient responsibility on each encounter before any statement goes out. Patients get one clear bill with the amount they owe, and your staff gets fewer billing calls.
RESULTS ACROSS 275+ PRACTICES
Results California practices can expect
These figures are company-wide averages across Qualigenix client practices, not California-only results.
98%
Claim accuracy rate
4.8%
Denial rate
97.7%
Net collections rate
Reduced from 54 to 36
Days in A/R
Reduced to 38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$1.6B+
Total charges handled
$923M+
Accounts receivable recovered
1,400+
Providers set up nationally
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix brings most California practices live by day 6, in four steps.
01
Onboarding call
We review your current billing setup, payer mix and denial trends by payer, including your Medi-Cal plans.
02
Software and portal setup
We set up access inside your existing EHR and connect to your payer portals, Medi-Cal's included. No software change.
03
Account clean-up
Open authorizations, unbilled charges and aged claims are sorted so nothing is lost in the switch.
04
Go live by day 6
New visits run through the full cycle, and older A/R is worked in parallel.
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WHY PRACTICES CHOOSE QUALIGENIX
Why California practices choose Qualigenix
Independent practices across California partner with Qualigenix for consistent cash flow and high claim accuracy.
One team from eligibility to payment
The person who sees a denial can reach the person who checked eligibility. Qualigenix keeps all eight revenue cycle steps on one team, so California problems get fixed where they start instead of passed between vendors.
Works inside any EHR
Qualigenix works inside 133 EHR and practice management platforms. Your staff keeps the system and workflows they know, and every action we take is logged in your software.
Monthly reporting by payer
Each month you see collections, denials, days in A/R and aging split by payer, so you can tell whether a Medi-Cal plan or a PPO is slowing your cash. Every metric comes with its definition.
6-day average onboarding
Qualigenix brings practices live in 6 days on average. Older claims are worked alongside new ones during the switch, so your California revenue doesn't dip while the new team starts.
HAVE QUESTIONS?
Frequently asked questions
Frequently asked questions about our setup and support in California.
Qualigenix is a revenue cycle management company that serves independent practices in California and 47 other states. We handle eligibility, authorization, coding, billing, posting, denials, A/R and credentialing for all payers in 38+ specialties. Talk to a revenue cycle specialist at 786-259-0231 to see if we fit.
Qualigenix RCM covers eight connected services: insurance verification and benefits, prior authorization, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing. Patient billing and monthly reporting are included. One team runs all of it inside your EHR.
Yes. Qualigenix submits and tracks authorizations with Medi-Cal plans, Medicare Advantage plans and commercial payers. We track each request against its deadline, which is five business days for standard commercial requests under California law and 7 calendar days for Medi-Cal managed care and Medicare Advantage plans.
Qualigenix verifies Medi-Cal eligibility for each month of service, files within Medi-Cal's six-month window and adds the National Drug Code Medi-Cal requires on drug lines. Medicare claims go to Noridian, and crossover claims are followed through to the Medi-Cal payment.
Qualigenix cuts days in A/R by stopping denials at the front end and working every open claim daily by payer and age. Across client practices, days in A/R fell from 54 to 36. For California plans, we also chase late payments that owe interest.
Qualigenix charges a percentage of collections, so our fee tracks what your practice actually receives. The rate depends on your specialty, volume, payer mix and which services you use. A revenue cycle specialist can quote your practice after reviewing your numbers.
Qualigenix brings most practices live by day 6. We review your setup, connect to your EHR and payer portals, clean up open items and go live. Older A/R is worked in parallel, so collections keep moving during the switch.
Yes. Qualigenix signs a Business Associate Agreement with every practice before accessing patient data. All work happens inside your EHR or over secure connections, and access is limited to your assigned team. Ask us for our security overview.