What operators ask before they hand us their billing

We review your recent ALW, RH, and ILS submissions and remittances, usually the last six months of RADs and any rebill records, and return a written summary of what was unbilled, denied, short-paid, or recoverable, grouped by cause. You see the size of the problem and what is driving it. The corrected claims and rebill files are produced once an agreement is in place.

Most facilities pay 3% of collected waiver revenue, invoiced as remittances pay, with a modest monthly minimum. Small single-site homes get a flat monthly rate. Historical recovery is priced on results: a share of what actually pays, nothing on what does not. Details are on the pricing page.

Usually, yes. A single home with four waiver residents collects on the order of $60,000 a month from Medi-Cal, and a single missed month for one resident costs more than a year of our fee. Starter pricing is set for small homes, and the introductory first month lets you see the difference before committing.

Software gives you a tool; someone in your office still has to learn Medi-Cal's rules, build the claims, read every remittance, and chase what did not pay. We do that work and are accountable for the result. For most owners, the software subscription turns out to be the smaller cost.

Yes. After the pilot month, a six-month initial term, then month to month with 30 days' notice. The pilot is the exit ramp: if the first cycle does not show results, you walk away. The agreement also covers the Business Associate Agreement, data ownership (yours), and our tooling (ours).

Facility NPI and Medi-Cal provider information, the current resident roster with ALW tiers and approved RH hours, recent RADs, and read access to the Medi-Cal Provider Portal or your existing submitter account. For ILS, the Kaiser clearinghouse credentials. We handle enrollment steps that are missing.

Yes. We run the waiver and ILS programs. Private-pay invoicing stays with your office unless you ask us to take it on.

Yes. We guide ALW and RH enrollment, including the Medi-Cal provider application and the Care Coordination Agency relationship, and begin billing as residents are approved.

Yes. We operate as a business associate and sign a Business Associate Agreement with every client before any resident data is exchanged. Resident data is handled on encrypted systems with access limited to the people doing the work.

The claim is the same. The difference is the receipt. Electronic claims are confirmed within hours, so a problem is corrected the same day instead of discovered on a remittance weeks later. See how electronic submission works.

Assisted Living Waiver services are billed per day at the resident's approved tier. Residential Habilitation is billed in 15-minute units against the hours approved by the Care Coordination Agency. Rates are set each year by DHCS, and both are billed under your facility's own provider number. We keep the current rates and rules on the Community Hub.

The Remittance Advice Details report is Medi-Cal's weekly statement of what was paid, denied, and adjusted. Denied lines do not change the deposit, which is why they are easy to miss. We reconcile every line to the claim that produced it. See how remittance review works.

Medi-Cal's standard billing limit is six months from the month of service, with documented delay reasons allowing later submission in specific situations. Part of the review is identifying which balances are still inside the window and prioritizing them.

Always, and separately. Recovered means tied to a later remittance payment. Pending, under appeal, and identified-but-unconfirmed amounts are reported in their own columns and never added to the recovered figure.

Yes. We will do the review so you know where you stand, and we will be here when the contract comes up for renewal.