California practices, Noridian rules first

Cardiology billing services in California

Sources checked: 2026-09-30. Sources and review scope.

Cardiology billing services in California start with Noridian, your Medicare contractor for jurisdiction JE. Its published coverage policies are one part of Medicare claim requirements. Policies can overlap across contractors, so payment under one contractor doesn't guarantee payment under another. Commercial and Medi-Cal routes depend on the member's plan and provider contract. We bill cardiology only, at 3% of collections.

Talk to our team Explore pricing

3% of collectionsNo setup feeNo contract

Cardiology billing services in California: a cardiologist and a sonographer reviewing an echo in a Los Angeles office — California claims go to Noridian

01Medicare

How Noridian pays cardiology in California

Noridian processes Medicare claims for jurisdiction JE: California, Hawaii, Nevada and the Pacific territories. It writes its own local coverage policies for echo, nuclear imaging, vascular studies and cardiac monitoring. A study that pays under one contractor can be denied under another.

CMS fee-schedule files map service locations to payment localities. We check the current ZIP-to-locality and rate information for the practice address and date of service rather than assume that a city name determines the rate.

Service ZIP confirmed

Claim 40126Carotid duplex · POS 11

93880Carotid duplex, both sidesChecked
DiagnosisOn Noridian policyChecked
NoteIndication documentedChecked
Service ZIPZIP and date checked in CMS filesChecked
Claim statusPaid

Noridian policy, checked per claim

02Payers

The California payers we bill

Your schedule carries Anthem Blue Cross, Blue Shield of California, UnitedHealthcare, Aetna, Cigna and Health Net. Medi-Cal managed care plans differ by county, such as L.A. Care in Los Angeles.

Many HMO plans delegate to IPAs and medical groups under capitation. Each contract has a division of financial responsibility, or DOFR. It says which services the IPA pays and which the health plan pays. Bill the wrong party and the claim comes back unpaid. We keep each DOFR and route every claim to the party that owes it.

Routed by the DOFR

Claim 40158Nuclear SPECT · HMO patient

CheckedPatient assigned to an IPA
RoutedDOFR puts this study on the plan
PaidBy the health plan

Billed to the party that owes

03Your city

Cardiology practices we serve in Los Angeles, San Diego, San Francisco, Sacramento

We're built for independent practices of 1 to 10 cardiologists. Echo, vascular, nuclear or monitors run in the office. In Los Angeles that often means several IPA contracts and a mixed HMO and PPO schedule.

In the Bay Area and Sacramento, Kaiser Permanente cares for many patients inside its own system. An independent practice bills the plans that remain and has to get each one right.

HMO and PPO billed apart

Claims 40171, 40172Echo 93306 · POS 11

HMO · IPA assignedClaim 40171

IPA

Sent to the IPA, per the DOFR

Claim statusPaid

PPOClaim 40172

Health plan

Billed to the plan at your contracted rate

Claim statusPaid

Each claim billed to its payer

04Switching

Switching from a local biller

Leaving a biller who never learned your IPA contracts? The switch runs on a 60-day plan. Claims keep moving while we work the old A/R and sort capitated claims from fee-for-service ones.

Your dedicated biller learns your contracts and your doctors, and stays with you.

Your first 60 days with us

Sorted as we go

Your first 60 daysCalifornia practice

Every IPA contract and DOFR on fileChecked
Capitated claims split from fee-for-serviceChecked
Old A/R worked in parallelChecked
New claims sent dailyChecked
Your claimsMoving

Contracts sorted in the first weeks

05Questions

FAQ

Do you bill IPA contracts?

Yes. Capitated services go to the IPA as encounters, per the division of financial responsibility. Carve-outs go to the party the DOFR names.

Do you handle Medi-Cal managed care?

Yes. We bill each Medi-Cal plan by its own rules, county by county.

What does it cost?

3% of collections. No setup fee, no contract, no per-claim charges.

Sources and review context

Checked on September 30, 2026. This administrative source check is not a clinical or credentialed coding review, legal opinion, payer-contract audit, or guarantee of coverage or payment.

Medicare contractor: CMS's JE jurisdiction page identifies California, Hawaii and Nevada in jurisdiction JE. CMS's MAC directory links state provider websites.
Fee schedule and locality: CMS's CY 2026 Physician Fee Schedule locality data and CMS fee-schedule downloads and ZIP-to-locality guidance support checking a service ZIP and date. No city-to-rate assertion is made here.
Medi-Cal: DHCS's managed care plan list by county supports the county-based plan context; Medi-Cal provider resources provide billing and claims assistance information.
Commercial payer: BCBSA's state company directory lists Anthem Blue Cross and Blue Shield of California. It does not establish market share, plan availability in a county, or a specific contract's terms; verify the member's product and provider agreement.

06Get in touch

Send us your last 90 days of claims

We review them by study and by payer, free, with no strings.

Talk to our team Explore pricing

3% of collectionsNo setup feeNo contract

Free, no strings

Your 90-day California reviewLast 90 days

Every claim, by studyIncluded
IPA and plan claims, sortedIncluded
Checked against Noridian policyIncluded