The remittance is where the money is actually decided
Every week Medi-Cal sends a remittance that says what it paid, what it denied, and what it took back. Most facilities file it. We reconcile it: every line matched to the claim that produced it, every short pay explained, every fix queued for the next cycle.
The deposit matches. The remittance still has problems.
A remittance has four parts: the payment summary, the lines that paid, the lines that were denied, and adjustments to earlier payments. The deposit reconciles to the first and second. Denials and adjustments do not, which is why they are so easy to miss when the money looks right.
- Paid lines checked against the rate and days billed, not just the total
- Every denial classified by cause and assigned a next step
- Adjustments traced to the original payment to confirm they were correct
- Short pays caught the week they post
Codes become actions, not paperwork
Medi-Cal explains every denial with a code. We translate each one into a cause the facility can understand and a step we take on your behalf. Most denials on waiver claims fall into a handful of patterns, and each has a known fix.
- Eligibility gaps confirmed with the Care Coordination Agency, then rebilled
- Duplicate and overlapping claims resolved against prior payments
- Quantity and rate mismatches corrected and resubmitted
- Anything requiring an appeal or inquiry handled by us
Illustrative examples drawn from real remittance patterns.
The person who sends the claims is not the only one who checks what paid
Submission and remittance review are separated on purpose. One side builds and sends; the other reconciles and reports. Each catches what the other would miss, and neither grades its own work.
- Weekly variance report by facility, resident, and program
- Open items tracked until they close, with the date they entered the queue
- Recovery reported only when the remittance proves it
A typical stabilized week after cleanup.
How we find what was missed, and why the number holds up
Pull six to twelve months
Remittances, rebill records, and any clearinghouse evidence for every program you bill.
Remove the overlaps
Rebill batches often cover the same dates. We de-duplicate before anything is counted, so the exposure figure is one you can defend to an owner or an auditor.
Rebill inside the window
Medi-Cal allows six months from the month of service. We prioritize what is closest to the deadline and track each item until it pays.
Send us six months of remittances. We will tell you what they are hiding.
The free review returns a written summary of paid, denied, and recoverable dollars by cause, with the overlaps removed so the number holds up.