California dental billing operates under regulatory complexity most out-of-state vendors never fully master. TransDontics’s 1,100+ California-credentialed specialists manage your complete revenue cycle from eligibility verification to final payment posting, so your collections stay optimized and you stay focused on patients.
California’s dental market blends fee-for-service with county-specific DMC plans, AB 952’s ERISA disclosure requirements (enacted 2023, effective January 1, 2025), and Dental Board standards affecting claim defensibility. Starting July 1, 2026, Medi-Cal limits adult dental coverage to emergency services for members ineligible for full-scope coverage due to immigration status.
California’s Dual-Track Medi-Cal Dental Structure: FFS and DMC
California AB 952: The ERISA Disclosure Law Every Biller Must Know
DSO Expansion and the California Multi-Location Billing Challenge
California’s Layered Privacy Compliance: HIPAA, CMIA, and CCPA
TransDontics’s 1,100+ in-house dental billing specialists are supported by RPA automation engineered for California’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
Most billing companies are fully manual or fully automated. TransDontics deploys both. RPA manages eligibility checks, ERISA flagging, claim scrubbing, and payment posting. Specialists own appeals, EOB reconciliation, prior auth follow-up, and payer escalations.
Every payment is reconciled against your contracted rate, line by line, across every payer. When Delta Dental of California or any commercial carrier pays below the agreed fee on a specific plan type, we flag it and file the appeal within 14 days. Most practices only catch outright denials. We go further.
Before every commercial claim goes out, we confirm whether the patient's plan is state-regulated or ERISA. A DMHC appeal on an ERISA plan is automatically rejected. A plan administrator appeal on a state-regulated plan follows a different legal framework. We route every appeal correctly from day one.
Claims processed within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, and no hidden costs buried in the fine print. Our fee is a nominal percentage of what we successfully collect from payers on your behalf. We only earn when you get paid.
Expert CDT coding, clean claim submission, and aggressive denial management by specialty-certified billers. 98% first-pass clean claim rate.
Get in-network faster. We handle all payer paperwork, CAQH maintenance, renewals, and compliance tracking so you start seeing insured patients.
Robotic process automation eliminates manual repetitive tasks. Eligibility checks, reminders, and daily reports run without human intervention, 24/7.
Full revenue cycle coverage from patient registration to final payment. We manage all claims, close every gap, and maximize your collections.
Strategic oversight of your practice’s operational and financial performance. We track collections, payer mix, and productivity metrics
Complete front office billing support covering patient billing inquiries, insurance comms, prior auth, and appointment-linked verification.
HIPAA-compliant dental transcription delivered fast and accurately. Clinical notes, procedure documentation, and patient records are transcribed.
We review your last 12 months, find your top 3 revenue leaks, and show you exactly what we fix. Practices often discover recoverable revenue.
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An in-house biller knows your practice but not California’s 180-day Medi-Cal filing cap, ERISA appeal routing, or how the July 2025 DMC transition affects your patient mix. Turnover resets that knowledge. Ours doesn’t.
Most billing companies submit claims. They won’t identify ERISA plans at eligibility, reconcile every EOB against your contracted rate, or chase the revenue that a clean submission still leaves uncollected.
Most billing companies are a service. TransDontics is a system: RPA catching what humans miss at volume, experienced billers catching what automation cannot judge. The result is a consistent first-pass rate of 98%.
Three steps. No disruption. No risk.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
Three steps. No disruption. No risk.
We review your claims, A/R, and denial patterns at zero cost. Most practices find 5–10% in hidden revenue leakage.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
We don’t publish named case studies because most clients prefer to keep billing performance private. What we can share is what the numbers look like across practices with comparable payer profiles.
Based on aggregated results across dental practices in comparable payer environments.
| Metric | Before TransDontics | After TransDontics |
|---|---|---|
| Average Denial Rate | 8–12% | Under 2.3% |
| First-Pass Clean Claim Rate | 70–80% | 98% |
| A/R Over 90 Days | 30–40% of Total AR | Reduced by 30%+ |
| Average A/R Resolution | 45+ Days | 18–25 Days |
| Claim Turnaround | 3–5 Days | 48 Hours |
| Revenue Growth (120 days) | Baseline | 5–12% Increase |
A Los Angeles general practice came to us with a 10% denial rate, 35% of A/R past 90 days, and commercial claims denied because ERISA appeal paperwork was routing to DMHC instead of the plan’s federal administrator. Front desk were spending 2–3 hours daily on billing calls.
Our specialists know every California payer’s submission rules, fee schedules, and appeal processes. National billing companies misroute ERISA appeals and generate irreversible rejections. We don’t.
Administered by DHCS and processed through Delta Dental. Adult benefits fully restored January 2022. PAVE portal enrollment required, 180-day timely filing enforced under W&I Code §14104.3. We track Manual of Criteria coverage and SMA updates in real time.
Whatever dental insurance your practice accepts, we ensure you get paid. TransDontics’ billing experts navigate the complexities of every major dental insurance network to maximize your revenue.
Our team handles California claims daily; knowing Medi-Cal’s 180-day filing window, that 40% of commercial patients are on ERISA plans requiring different appeal pathways, and that the July 2025 DMC transition created routing gaps still showing in A/R reports.
Every California practice qualifies. If your city isn’t listed, it’s coming. Reach out now and we’ll onboard your practice without delay.
Whether you practice in Orange County or rural Shasta County, TransDontics knows your payers, your plans, and exactly how to get your claims paid.
Every state has its own payer rules, Medicaid structure, and billing landmines. TransDontics expertly navigates all of them.
California dental practices carry federal HIPAA obligations alongside CMIA (Civil Code §56.10), CCPA (Civil Code §1798.100), and Dental Practice Act requirements. TransDontics is HIPAA certified and AICPA SOC 2 Type II compliant.
All patient data is encrypted end-to-end, satisfying HIPAA Security Rule technical safeguards, CMIA electronic health information protections, and CCPA data security requirements. Every data transmission meets the highest applicable standard.
Only credentialed TransDontics personnel can access your practice data, eliminating the internal access vulnerabilities that turn in-house billing into a compliance liability most California practice owners don’t realize they are carrying until it is too late.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. Everything is documented and third-party verified. Your California practice’s liability exposure is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
In-house billing looks cheaper on paper. In California, it rarely is. High biller salaries, Cal/OSHA compliance costs, chronic turnover, training expenses, and unworked denials mean most California practices are spending more than they recognize and collecting less than they should.
Average California salary
Benefits + Payroll Taxes
Software + Training
Turnover Cost
Average Denial Rate
First-Pass Clean Claims Rate
Setup Fee
Contract
~$54,000/yr
~$16,200/yr
~$5,000/yr
~$81,000/replacement
8–12%
70–80%
—
—
Included
None
Included
None
Under 2.3%
98%
$0
Cancel Anytime
*Salary benchmarks based on California BLS/ZipRecruiter data. Results vary by practice size and payer mix.
Our Complimentary audit covers denied claims, ERISA vs. state-regulated appeal routing, and underpayments, no obligation, no pitch.
Specific, verified outcomes, not generic praise. Every metric sourced from client data.
In the first 60 days, TransDontics recovered $18,400 in claims our team had written off as uncollectable. They caught 47 denied claims we had given up on. The Dentrix integration was seamless as they were billing the same day.
General Dentist · Austin, TX
I was spending 3 hours a day chasing orthodontic claims. TransDontics took over and our denial rate dropped from 22% to under 4% in three months. The multi-visit treatment plan billing alone recovered $31K we had been losing annually.
Orthodontist · Los Angeles, CA
We run 3 oral surgery locations on Eaglesoft. The OMS anesthesia cross-coding was a mess; TransDontics cleaned it up in week one. Collections are up 11% across all three locations.
Oral Surgeon · Dallas, TX
Four factors: Medi-Cal’s 180-day timely filing window, roughly 40% of commercial patients on ERISA plans requiring federal appeals, AB 952’s ERISA identification requirement, and the July 2025 DMC plan transition in Los Angeles and Sacramento creating credentialing gaps still appearing in A/R reports today.
RPA handles eligibility checks, ERISA plan flagging, claim scrubbing, status tracking, and payment posting automatically. Billing specialists handle appeals, EOB reconciliation, pre-auth follow-up, and payer escalations. The combination sustains a 98% first-pass rate. Either layer alone doesn’t achieve it.
AB 952 was passed in 2023 and took effect January 2025, requiring dental plans to disclose whether coverage is state-regulated or ERISA. ERISA denials require federal appeal processes; state-regulated denials go through DMHC or CDI. Filing to the wrong body means automatic rejection; a core billing competency, not a minor compliance detail.
No setup fee. No monthly minimum.
Cancel anytime.
Response within 24 hours.
HIPAA-compliant from day one.
Pay only a percentage of what we collect for you
