Medi-Cal and Medicaid Payments

Eligibility, Billing Appeals, and Treatment Authorization Issues

The criteria which an individual must meet in order to establish his/her eligibility for medical assistance are set forth by statute and administrative rules and regulations. The responsibility for securing Medi-Cal and Medicaid for patients has now fallen upon the healthcare provider. Time limitations regarding filing of applications and requesting fair hearings complicate this program. Once the administrative process is complete, SAC is one of the few firms that provide a legal vehicle to overturn wrongful denial of benefits, denied treatment authorization requests (TARS), or billing denials.

  • Clients can elect to include eligibility programs as an element of the provision of SAC’s services
  • SAC specializes in Treatment Authorization Request (TAR)  Denials and Billing Appeals

SAC’s extensive staff of specialists, including nurses and physicians, is well trained in billing, medical records review and follow-up of third-party accounts. If claims are improperly denied, appeals and actions are filed to obtain resolution or pursue arbitration under appropriate contractual dispute resolution procedures.

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