Every county runs its own Mental Health Plan, on top of a separate managed-care track for mild-to-moderate care. That split not the state's size is what drives most of your denials. We bill for California behavioral health practices remotely, working the rules the way California actually wrote them.
No local office required — the rules we work from are the state's, not ours.
Since 2014, Medi-Cal has split behavioral health between counties and managed care plans, with a third track for substance use. Nothing on a claim tells you which one to bill level of need does.
Handles specialty care serious mental illness, serious emotional disturbance, and higher levels of care. One per county, overseen by DHCS.
Handles mild-to-moderate mental health, often subcontracted to a Managed Behavioral Health Organization.
Almost every avoidable denial we see in California behavioral health billing traces back to one of these.
Send a specialty claim to the health plan, or a mild-to-moderate claim to the county, and it bounces back CARC 109 not covered by this payer, because for that member, on that day, it genuinely wasn't.
SB 855, in effect since 2021, requires plans to use clinical criteria consistent with generally accepted standards of care a direct response to Wit v. United Behavioral Health. That's real appeal language for PHP, IOP, and residential claims, if the appeal cites the right standard.
A county MHP claim is often billed in Short-Doyle format time-based codes like T2021 or T2024 while the same service billed to an MCP uses ordinary codes like 90837. Miscoding between formats is a leading reason county claims bounce.
DHCS's PAVE portal (60–120 days) is only step one. Billing still needs separate enrollment with every managed care plan in the county, and again with Drug Medi-Cal for SUD.
We treat routing as a front-of-process problem, not an appeals problem, and staff every account with people fluent in both coding systems.
We confirm, before a claim goes out, whether a member's level of need puts the service with the county MHP or the MCP because guessing produces the CARC 109s.
Coding is handled by staff fluent in both standard CPT and Short-Doyle time-based coding, converted correctly the first time.
When a level-of-care denial lands, our appeals cite the exact clinical-criteria standard SB 855 requires the plan to use not a generic reconsideration request.
We run the state PAVE application and per-plan enrollment with each managed care plan in the county at the same time, so a new location isn't left unbillable.
Every service below is run with the county-vs-MCP distinction as a first-class input, not an afterthought.
Confirming, before the first session, which system county or MCP is financially responsible, not just whether coverage is active.
Certified coders choosing between standard psychiatric CPT codes (90791, 90832/34/37, 90846/47) and county Short-Doyle equivalents.
837P submission built around each payer's edits an MCP's commercial-style adjudication or a county MHP's encounter-based reporting.
Traced to the actual cause routing, authorization, or level-of-care and appealed with the clinical standard California law requires the plan to use.
Reconciling MHP fee-for-service payments, MCP arrangements, and commercial EOBs into one clear picture of what a practice collected.
Managing PAVE enrollment, county-by-county managed care applications, and Drug Medi-Cal enrollment for SUD programs, in parallel.
Chasing aging balances against each payer's real timeline including the tighter 30-calendar-day standard California adopted for 2026.
Behavioral health billing isn't one specialty it's several, each with its own rules, litigation history, and documentation standard.
California trained a record 239 first-year psychiatry residents in 2025 still far short of the 527 a year state workforce planners say is needed, pushing more practices toward PMHNPs.
Sit closest to the SB 855 / Wit v. United Behavioral Health line challenged on medical necessity more than almost any other service, where correctly-cited criteria matter most.
Works in the shadow of Rea v. Blue Shield of California (2014), which required parity-act coverage of medically necessary residential care still the reference point in RTC disputes.
Regularly involves holds under the Lanterman-Petris-Short Act — the 72-hour "5150" and 14-day "5250" which still generate ordinary claims requiring documentation that supports medical necessity.
Runs through Drug Medi-Cal or DMC-ODS depending on the county, with ASAM criteria driving authorization and appeals alike.
California isn't a PSYPACT state a psychologist treating a California patient by video needs a full California license, no compact shortcut, regardless of where the practice is based.
Clean revenue cycle starts before the appointment and doesn't stop until a claim is paid.
Not just active or inactive which system owns the visit.
Where required, before the service is delivered.
Coded correctly for that specific payer Short-Doyle or standard CPT.
No claim sits waiting for someone to notice it bounced.
AB 3275, effective January 1, 2026: every California health plan and insurer HMOs and Medi-Cal managed care included must pay, contest, or deny a claim within 30 calendar days, replacing the old, uneven 30- and 45-working-day standards, with automatic interest owed on anything late. We track receipt dates against that clock, county by county.
California's behavioral health workforce shortage isn't limited to clinicians it reaches billing staff who know Short-Doyle from standard CPT, or which county plan a claim belongs to. That expertise is costly to hire and hard to keep.
If Medi-Cal's two-system split, a county's Short-Doyle rules, or a level-of-care denial is costing your practice time or revenue, we're glad to take a look.