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.

Approximately 2 million Medi-Cal members with unsatisfactory immigration status will move from managed care to Medi-Cal fee-for-service on January 1, 2027. Physicians who want to continue caring for affected patients should confirm that they are enrolled and eligible to bill Medi-Cal FFS through PAVE using their Type 1 NPI. Practices should also review the Medi-Cal FFS fee schedule, claims process and Treatment Authorization Request requirements, because services will no longer be paid under managed-care contracts. Ask contracted plans which patients may transition and begin mapping continuity needs now. DHCS plans additional guidance for people receiving ongoing or complex treatment later this year.

CMA practice guidance

Blue Shield of California has expanded its Availity Essentials authorization workflow. Practices can now submit and manage most eligible outpatient authorizations for Federal Employee Program PPO and U.S. Postal Service PPO members who live outside California. The platform supports medical services, medical-benefit drugs and behavioral-health requests, including ABA services. Availity already supports listed Blue Shield commercial PPO, group Medicare Advantage PPO, ASO and Shared Advantage plans.

Practices should confirm their Availity registration, select “Blue Shield of California,” and review Blue Shield’s current FAQ to verify that the patient’s plan and requested service are eligible before submitting.

Primary source: Blue Shield provider announcement

The Cooperative of American Physicians (CAP) invites you to join us for an evening mixer to recognize and celebrate the contributions of California’s independent physician community. Enjoy complimentary refreshments, appetizers, and engaging conversation with your fellow physician colleagues.

RSVP NOW

Space is limited.

Noridian has released its latest quarterly provider update, highlighting several important Medicare billing, compliance, and educational resources for physician practices. We’ve summarized the most relevant updates below. The complete Noridian newsletter is available at the bottom of this page.

Key Updates

Medicare Secondary Payer (MSP) Form Now Available in the Noridian Medicare Portal

As of June 19, 2026, providers can now submit the Part B Medicare Secondary Payer (MSP) Correspondence Formdirectly through the Noridian Medicare Portal (NMP) instead of mailing it. Supporting documentation can also be uploaded electronically, streamlining requests related to previously processed claims.

This submission option is intended for requests involving:

• Claims unrelated to No-Fault, Workers’ Compensation, Liability, or Medicare Set-Aside cases

Noridian has released its latest quarterly provider update, highlighting several important Medicare billing, compliance, and educational resources for physician practices. We’ve summarized the most relevant updates below. The complete Noridian newsletter is available at the bottom of this page.

Key Updates

Medicare Secondary Payer (MSP) Form Now Available in the Noridian Medicare Portal

As of June 19, 2026, providers can now submit the Part B Medicare Secondary Payer (MSP) Correspondence Formdirectly through the Noridian Medicare Portal (NMP) instead of mailing it. Supporting documentation can also be uploaded electronically, streamlining requests related to previously processed claims.

This submission option is intended for requests involving:

• Claims unrelated to No-Fault, Workers’ Compensation, Liability, or Medicare Set-Aside cases

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…

WATCH NOW! Margin Rescue: Hidden Expenses and Untapped Revenue in Your Primary Care Practice explores the financial and operational challenges quietly impacting independent primary care practices and the practical strategies physicians can use to strengthen sustainability without sacrificing patient care. Presented by leaders from Elation Health, this session examines how fragmented systems, inefficient workflows, administrative burden, and billing gaps contribute to rising costs and clinician burnout, while also highlighting new revenue opportunities available in 2026 through programs such as Advanced Primary Care Management (APCM), Transitional Care Management (TCM), and Remote Patient Monitoring (RPM). The discussion also covers how AI-powered tools, automation, and integrated technology can improve coding accuracy, streamline claims management, reduce administrative strain, and help practices capture reimbursement for the care they are already delivering.

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

WATCH NOW! This webinar, Are You Getting Paid for the Care You’re Already Delivering?, highlights how physicians can better navigate the evolving business landscape of medicine, with a focus on revenue optimization, operational efficiency, and adapting to ongoing payment and policy changes. Featuring practical insights and real-world perspectives, it offers actionable strategies physicians can apply to strengthen their practice and long-term stability.

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

Get your free copy of 8 Key Strategies to Increase Your Practice's Profitability, a practical guide designed to help you and your staff optimize operations, uncover revenue opportunities, and reduce unnecessary costs. Created by the Cooperative of American Physicians (CAP), this resource delivers straightforward, actionable tools you can put to work immediately for measurable impact.

Download Your Free Guide

This guide provides strategies to:

WATCH NOW! In this educational session, Nicole Green of Robert Hall & Associates will walk physicians through the most common income structures seen in the medical field and explain how those structures directly impact taxes, cash flow, and decision making. This presentation is designed to bring clarity to areas that are often overlooked, misunderstood, or discovered too late in the filing process.

As 2026 begins, primary care practices are navigating a fast-changing policy environment with major implications for payment, risk, and day-to-day operations. This on-demand webinar, “2026 Health Policy Update: What Primary Care Practices Need to Know to Succeed,” is designed to help you quickly get oriented—and turn complex rules into practical next steps for your practice.

In this 30-minute session, Penny Morris, MPH, CIPM, Senior Regulatory and Compliance Manager at Elation Health, breaks down the most important federal updates affecting primary care in 2026

This program offers valuable guidance and actionable strategies for managing adverse patient outcomes. You will gain practical insights from CAP’s risk management experts, who will demonstrate effective follow-up techniques to build trust with patients and their families and help you mitigate the serious liability risks associated with adverse events.

Ongoing compliance education is essential to protect your practice, support your team, and uphold high standards of care. >>>

A strategic, streamlined approach to training new healthcare employees that improves team performance, compliance, and patient care. >>>

Free online practice management course developed by the Cooperative of American Physicians (CAP) to help independent medical practices effectively manage their administrative and business operations.

Discover six self-paced modules covering the critical areas of practice management.

Improve Operations. Strengthen Outcomes. Maximize Revenue | CMA’s Practice Transformation resources are designed to help physicians and practice leaders build smarter, more sustainable systems of care. From data optimization to care coordination, these tools support quality improvement efforts while aligning with changing payment models and regulatory requirements. >>>

CMA’s Center for Economic Services (CES) provides one-on-one practice management assistance to physician members and their staff. Our goal is to empower physician practices by providing resources and guidance to improve the success of the practice. Assistance ranges from coaching and education to direct intervention with payors or regulators. CES also develops resources and tools to assist practice. >>>

In this session, Dr. Sara Pastoor and Manisha Goud explore the hidden costs threatening primary care in 2025—and share actionable strategies to help practices regain both time and financial stability.