BOM Toolkit

A new California law gives practices a minimum window to fix eligible claims after a denial or overpayment notice.

A correctable claim defect should prompt a billing-team review before it becomes a write-off.

SB 1049, signed and chaptered September 30 as Chapter 1001, Statutes of 2026, takes effect January 1, 2027.

The law gives claimants at least 90 calendar days from a covered plan or insurer’s most recent action to submit a corrected claim when a denial, partial denial or overpayment notice is based wholly or partly on a defect that a corrected claim can remedy.

A corrected claim submitted under this protection cannot be denied because another filing deadline has expired. Disputes involving those corrected claims must be eligible for submission to the payer’s dispute-resolution process.

What your practice can do now

Purpose: Keep correctable claims moving, preserve dispute rights and prevent avoidable write-offs.

SB 1049 update — effective January 1, 2027: For covered plans and insurers, a denial, partial denial or overpayment notice based wholly or partly on a correctable claim defect triggers a minimum 90-calendar-day correction window from the payer’s most recent action. A corrected claim submitted within that protection cannot be denied because another filing deadline expired. Related disputes remain eligible for the payer’s dispute-resolution process. This is not a blanket extension of appeal deadlines or a guarantee of payment.

1. Capture the notice and assign ownership

• Record the payer, plan/product, claim number, dates of service and disputed amount.

• Save the complete denial, partial-denial or overpayment notice, including reason codes.

• Record the date of the payer’s action and the date received separately.

California has released multilingual guidance on the federal public-charge rule that took effect September 18, 2026. The rule may affect some immigration decisions, but it does not determine whether someone qualifies for Medi-Cal, CalFresh or other public benefits, and it does not apply to everyone. Practices can help by sharing the CalHHS guide and self-assessment tool, while directing case-specific questions to qualified immigration legal-service providers. Avoid interpreting immigration requirements for individual patients. Front-office and care-management teams may also want the state resource page bookmarked so patients receive consistent, trusted information before changing coverage or benefits.

California’s public-charge resources

DHCS webinar for providers and advocates on Wednesday, September 30, 2026, from 10 to 11 a.m. Pacific time.

Approximately two million Medi-Cal members with Unsatisfactory Immigration Status are expected to move from managed care to fee-for-service on January 1, 2027, according to a September 2026 DHCS Policy Guide. The change affects how members obtain care and how providers are paid. It does not, by itself, end members’ Medi-Cal eligibility; members must continue to renew on time to keep full-scope coverage.

For practices, the immediate question is whether they can continue caring for affected patients through Medi-Cal fee-for-service. Members will be able to see doctors, clinics and hospitals that accept fee-for-service, with the state paying providers directly for covered services. Practices should check their enrollment and billing readiness, along with applicable authorization requirements, before the transition.

Care continuity also needs attention. Patients with ongoing treatment, scheduled procedures or medical equipment may…

Federal Medi-Cal eligibility changes taking effect in 2027 could create new coverage disruptions for some Los Angeles County patients.

Beginning January 1, 2027, certain adults ages 19–64 in Medi-Cal’s adult expansion group may need to meet work, school, volunteer, or other qualifying activity requirements to maintain coverage. Beginning March 1, some affected adults may also need to renew eligibility every six months instead of annually.

Keep L.A. Covered has launched as a countywide resource to help residents understand the changes, respond to notices, and connect with enrollment assistance. LACMA is a coalition partner in the campaign.

What Practices Should Do

• Share KeepLACovered.org through patient portals, appointment reminders, after-visit summaries, and waiting-room materials.

• Encourage patients to update contact information so important Medi-Cal notices reach them.

CMS’s ACCESS model connects Original Medicare patients with participating organizations that provide technology-supported chronic care between office visits. Eligible Part B practitioners may receive a $30 co-management payment after reviewing an ACCESS care update and completing at least one documented coordination activity, such as reconciling medications or updating a problem list. CMS requires at least five minutes of practitioner time, and a $10 first-time onboarding add-on may apply. The payment is separate from distinct covered office visits. Practices should identify enrolled patients, confirm how updates enter the workflow and review CMS documentation and diagnosis-code requirements before billing.

Primary source: CMS billing guidance

Practices may have only five months before denials begin for orders, referrals and prescriptions from non-enrolled clinicians.

What changed: Yesterday’s brief noted that DHCS had not announced an enforcement date. CMA reported later September 2 that phased enforcement could begin as early as February 2027.

Who it affects: Physicians and other clinicians who order, refer or prescribe for Medi-Cal patients must be enrolled individually under a Type 1 NPI. Managed care, Medicare or Medi-Cal Rx enrollment alone does not satisfy the requirement.

Your move: Check every prescriber now. Applications can take up to 90 days, and submission alone does not prevent denials.

Review CMA’s enrollment guidance

As fall approaches, physicians and care teams will need to navigate updated immunization guidance, changes affecting Medi-Cal coverage, and emerging public health concerns.

On September 23, the Los Angeles County Department of Public Health will host a live CME session covering several issues that could directly affect patient care and practice operations this season.

Topics include:

• Updated COVID-19, influenza, and RSV immunization recommendations for the coming respiratory viral season

• Changes to Medi-Cal and efforts to help preserve patient coverage across Los Angeles County

• A clinical review of Cyclospora and current food and water safety considerations

Get practical guidance on building and maintaining a high-performing medical office team during CAP’s free webinar. The leading employment law attorneys from WorkWise Law, PC will discuss how today's medical practices can address unprecedented workforce challenges, including recruiting in a tight labor market, navigating evolving employment legal requirements, and managing the growing use of AI in hiring and workforce management.

Register Now

Recruiting and Managing High-Performing Medical Office Staff

Presented by WorkWise Law, PC

The annually updated Human Resources Manual for Medical Practices, offered for free by the Cooperative of American Physicians (CAP), is now available to download. This essential resource, which can cost you thousands elsewhere, addresses California's complex employment laws and provides policies that help prevent lawsuits and set clear workplace expectations.

Download Now

The Human Resources Manual for Medical Practices, available in a customizable Word format, includes separate handbooks for employees and managers.

It’s crucial to use the latest version of this HR manual as laws change frequently.

Part 2 of 2: Date: September 10, 2026 | Time: 12:15pm-1:30pm

REGISTER

Even the most well-organized physician practices can find themselves facing payor audits, downcoding, prepayment review, or requests for repayment based on coding analytics and statistical extrapolation methodologies that can create significant financial exposure. Independent and small-group practices are especially vulnerable because they may lack dedicated compliance and audit defense resources.

Join us for the second webinar in this practical two-part series focused on helping physicians, practice administrators, billers and practice leaders respond appropriately when coding concerns arise.

Participants will learn how to:

• Understand the types of payor reviews: Special Investigations Unit audit, prepayment review, Medicare Recovery Audit Contractor Medicare Administrative Contractor activity, and DOJ involvement.

Part 1 of 2: Date: August 18, 2026 | Time: 12:15pm-1:30pm

REGISTER

California physician practices are increasingly facing scrutiny from sophisticated payor analytics, downcoding programs and coding pattern reviews that often rely solely on claims data, without considering the complexity of the patients being treated. Independent and smaller practices are especially vulnerable because they typically lack the internal analytics and compliance resources available to large health systems.

This webinar will show physicians, office managers, billers, practice administrators and practice leaders how to use widely available AI tools, working with the standard summary reports any practice management system can produce, to perform their own internal coding-risk monitoring without needing specialized analytics expertise, expensive software or patient-level data. Participants will learn how to:

• Identify the practice management reports needed for effective self-audits.

• Analyze E/M distributions, modifier utilization, RVU concentration and coding trends over time using AI tools, without writing formulas, learning statistics…

The Cooperative of American Physicians (CAP) is pleased to offer its free online 4.5 CME*/CE** credit practice management course to help physicians and their staff manage the everyday demands of running a medical practice. The Successful Practice Manager provides clear and easy-to-follow guidance focusing on the business and administrative functions that impact patient care, operational efficiency, and revenue.

Physicians Enroll Here for 4.5 CME Credits

Practice Administrators Enroll Here for 4.5 CE Credits

The Successful Practice Manager covers six on-demand modules addressing:

The Cooperative of American Physicians (CAP) is pleased to offer its free online 4.5 CME*/CE** credit practice management course to help physicians and their staff manage the everyday demands of running a medical practice. The Successful Practice Manager provides clear and easy-to-follow guidance focusing on the business and administrative functions that impact patient care, operational efficiency, and revenue.

Physicians Enroll Here for 4.5 CME Credits

Practice Administrators Enroll Here for 4.5 CE Credits

The Cooperative of American Physicians (CAP) is now offering its free online 4.5 CME*/CE** credit practice management course to all California physicians and their staff. Previously only available to CAP members, The Successful Practice Manager provides clear and easy to follow guidance focusing on the everyday business and administrative functions that impact patient care, operational efficiency, and revenue.

Physicians Enroll Here for 4.5 CME Credits

Practice Administrators Enroll Here for 4.5 CE Credits

The Successful Practice Manager covers six on-demand modules addressing:

• Office Administration

• Human Resources Management