We Bill in All 50 States — Fluent in Your Jurisdiction’s Rules.
Most “States We Serve” pages are city lists next to a stock map. This one is a rule matrix: which Medicare contractor processes your claims and what its coverage policies restrict, your state Medicaid program’s filing limits and MCO map, your prompt-pay statute, your telehealth parity status, your gold-carding eligibility. Geography doesn’t decide whether you get paid — rules do. We know yours before day one.
- One team, no franchise handoffs: all 50 states + DC served by one accountable team — not a directory of “local partners” who’ve never seen your specialty’s rulebook
- Your MAC, by name: the 12 Medicare A/B jurisdictions mapped below — with the LCDs touching your top codes checked before your first claim goes out
- Your Medicaid, mapped: the program’s timely filing limit, its MCO list, and its carve-out routing — because 42 states + DC now deliver Medicaid through managed care (KFF)
- State reform, chased where it lives: gold-carding in Texas (HB 3812, effective September 1, 2026) and the other state laws, national payer programs like UnitedHealthcare’s, and CMS’s 72-hour / 7-day prior-auth clocks enforced since January 1, 2026
- Multi-state without multiple vendors: one licensure–enrollment matrix across every state you practice in — PSYPACT and compact status, per-state Medicaid enrollment, DEA telemedicine rules current through December 31, 2026
- The math doesn’t move: first-pass ≥95%, net collection ≥96%, A/R under 35 days — targets with formulas, reported identically whether you practice in Maine or Monterey
The “Local Biller” Myth — Where Your Claims Actually Travel
A claim doesn’t travel to your state capital. It leaves your EHR as an 837 file, routes through a national clearinghouse to your Medicare Administrative Contractor or the payer’s EDI hub, and comes back as an 835 electronic remittance. Every step of that pipeline is national — and none of it knows your biller’s zip code.
The plumbing is national
Clearinghouse connectivity, payer portals, PECOS enrollment, ERA/EFT registration — every system your revenue runs on is accessible from anywhere with credentials and discipline. The biller’s location has never appeared on a claim; the rules of the claim’s jurisdiction appear on all of them.
What your state actually decides
Not distance — rules. Which MAC processes your Medicare claims and what its LCDs restrict. Your Medicaid program’s filing limits and MCO structure. Your prompt-pay statute, your telehealth parity law, your expansion status, your workers’ comp and no-fault machinery. Nine rule layers, mapped below.
What “local” actually buys
A street address. Usually one biller — which means your denial backlog takes their vacation, their resignation is your revenue event, and their bench has no second opinion for a $9,000 cardiology claim. Proximity is comfort. Jurisdiction fluency is capability. They are not the same product.
The two-question test for any billing company claiming to serve your state
Ask them: (1) Which MAC processes our Medicare claims, and which of our top codes are restricted by an LCD in our jurisdiction? (2) What’s our state Medicaid program’s timely filing limit — and which MCOs in our state impose tighter ones? If the answers don’t come back in one sentence each, without googling, then “we serve your state” is a marketing sentence — not an operating fact.
What Actually Changes at the State Line — Nine Rule Layers We Track per Practice
Fifty states don’t mean fifty billing markets — they mean fifty stacks of rules layered on one national plumbing system. These are the nine layers that decide whether the same encounter pays or rejects, state by state.
| Rule layer | How it varies by state | What it decides |
|---|---|---|
| 1 · Medicare MAC & LCDs | 12 A/B jurisdictions run by 7 contractors; each publishes its own Local Coverage Determinations and billing articles | Whether a given CPT-with-diagnosis combination pays on first pass in your territory — the same code can reject one state over |
| 2 · State Medicaid program | 50 different programs; timely filing runs roughly 90 days to a full year (Medicare’s is 12 months nationally) | How fast unbilled work ages out of existence — a claim filed late in a 90-day state is donated care |
| 3 · Medicaid MCOs & carve-outs | 42 states + DC deliver through comprehensive MCOs — about 78% of beneficiaries nationally (KFF, 2024 data); behavioral health and pharmacy carve-outs vary | Whether claims route to the right payer at all — the classic silent killer of Medicaid revenue |
| 4 · Prompt-pay statutes | Most states: ~30 days electronic / ~45 paper for clean claims, with interest — Alabama adds 1.5% per month, Ohio 18% per year, Texas layers graduated penalties | Whether late payer payments carry penalties you can actually claim — if someone tracks the due dates |
| 5 · Prior-auth reform | Gold-card laws in TX (eff. Sept 1, 2026), LA, MI, VT, WV; national payer programs; CMS’s 72-hour/7-day clocks apply to MA, Medicaid & CHIP — not traditional Medicare | How much of your prior-auth workload is reducible, and which protections you can invoke today |
| 6 · Telehealth coverage & parity | 44 jurisdictions regulate private-payer telehealth — but only about half of those require true payment parity (CCHP, 2025); Texas added a coverage mandate effective Jan 1, 2026 | Whether your virtual visits pay like in-person ones or at a discount your margin never agreed to |
| 7 · Medicaid expansion | 40 states + DC expanded; 10 have not (AL, FL, GA, KS, MS, SC, TN, TX, WI, WY) | Your self-pay and patient-balance exposure — non-expansion states run structurally higher uncompensated care |
| 8 · Compacts & licensure | PSYPACT covers 42+ jurisdictions (Montana joined Oct 2025); California and New York remain outside — counseling and nursing compacts differ again | Which of your clinicians can legally treat which patients across state lines — the enrollment matrix follows the licenses |
| 9 · Workers’ comp & auto no-fault | Every state runs its own WC system — ND, OH, WA, WY as exclusive state funds; NY no-fault medical claims file within 45 days (Reg. 68); Michigan’s PIP tiers post-reform | Whether whole claim families have a home in your workflow — most billing companies quietly exclude them |
Why this table is the whole pitch
A billing company that serves “all 50 states” but can’t fill in this table for your state serves 50 states on paper and zero in practice. Every row above is something we load, check, and maintain for each practice — before the first claim, not after the first rejection wave. The rest of this page is those nine layers made concrete.
Your MAC Is Your Medicare Weather — The 12 Jurisdictions, Current for 2026
Medicare doesn’t process claims by state — it processes them by jurisdiction: twelve of them, run by seven contractors, each publishing its own LCDs, billing articles, portal, and processing rhythms. This is the table most billing companies can’t produce. Ours is maintained, not memorized — CMS recompetitions move it.
| Jurisdiction | Contractor | States | What we watch in this territory |
|---|---|---|---|
| JE | Noridian | CA · HI · NV (+ AS, GU, MP) | Medi-Cal — the nation’s largest state Medicaid program — and Med-QUEST MCO routing; California remains outside PSYPACT |
| JF | Noridian | AK · AZ · ID · MT · ND · OR · SD · UT · WA · WY | Rural and frontier practices — telehealth dependence, distance-sensitive specialty access, Oregon’s coordinated-care model |
| J5 | WPS | IA · KS · MO · NE | Plains payer concentration; Kansas in the non-expansion ten — self-pay balance discipline matters here |
| J6 | NGS | IL · MN · WI | Mature Medicaid MCO markets (Illinois, Minnesota) — carve-out routing and MCO-specific filing rules |
| J8 | WPS | IN · MI | Michigan’s reformed auto no-fault PIP landscape — a parallel payment system most billers exclude |
| JK | NGS | CT · ME · MA · NH · NY · RI · VT | New York no-fault’s 45-day filing discipline; MA and NY still outside PSYPACT for telepsych expansion |
| J15 | CGS | KY · OH | Ohio’s 18%-per-year prompt-pay interest — among the strongest in the country — plus its exclusive state workers’ comp fund |
| JH re-awarded 2026 | Novitas | AR · CO · LA · MS · NM · OK · TX | The reform jurisdiction: Texas gold-carding (HB 3812, eff. Sept 1, 2026) + Texas telehealth coverage mandate (Jan 1, 2026) + Louisiana’s gold-card law; contract re-awarded to Novitas June 24, 2026 — same seven states |
| JL | Novitas | DE · DC · MD · NJ · PA | Dense commercial markets with carve-out-heavy plan designs — behavioral health delegation is the norm, not the exception |
| JJ | Palmetto GBA | AL · GA · TN | Non-expansion cluster (AL, GA, TN) — structurally higher patient-balance exposure; Alabama’s 1.5%/month prompt-pay interest |
| JM | Palmetto GBA | NC · SC · VA · WV | North Carolina’s December 2023 expansion reshaped its payer mix; South Carolina remains in the non-expansion ten |
| JN | First Coast | FL (+ PR, VI) | One of the nation’s most Medicare Advantage–penetrated markets — MA plan rules dominate the Florida revenue cycle |
MAC transitions are an operating event
When CMS recompetes a jurisdiction, provider portals, EDI registrations, and correspondence rhythms change — CMS re-awarded JH to Novitas on June 24, 2026 (same contractor, same seven states, and CMS itself anticipates a smooth transition). We track these because our clients shouldn’t learn about them from a rejected claim.
Same code, different weather
LCDs are jurisdiction-specific: the covered diagnoses and documentation rules for a given service can differ between neighboring MAC territories — which is why “we check your LCDs” is per-jurisdiction work, not one-time national work. DMEPOS suppliers run on a separate four-jurisdiction DME MAC map we track for supplier clients.
Every State, Five Regional Briefs — What We Load Before Day One
All 50 states plus DC, grouped the way the rules actually cluster — by contractor territory, payer landscape, and state law. Find your state; that’s the operating context we arrive with.
Northeast
MACs: NGS JK (New England + NY) · Novitas JL (DE, DC, MD, NJ, PA)
Dense commercial markets with carve-out-heavy plan designs; strong telehealth private-payer laws. New York adds auto no-fault’s 45-day filing discipline — and MA and NY remain outside PSYPACT, which multi-state telepsych practices learn the hard way.
Southeast
MACs: Palmetto JM (NC, SC, VA, WV) · Palmetto JJ (AL, GA, TN) · CGS J15 (KY) · Novitas JH (MS) · First Coast JN (FL)
Florida pairs the First Coast jurisdiction with one of the country’s most Medicare Advantage–penetrated markets. The non-expansion cluster (AL, FL, GA, MS, SC, TN) means structurally higher patient balances — patient-payment discipline is not optional here. Alabama pays 1.5% per month prompt-pay interest, when tracked.
Midwest
MACs: NGS J6 (IL, MN, WI) · WPS J8 (IN, MI) · WPS J5 (IA, KS, MO, NE) · CGS J15 (OH) · Noridian JF (ND, SD)
Ohio stacks 18%-per-year prompt-pay interest on top of an exclusive state workers’ comp fund; Michigan runs its reformed auto no-fault PIP system; Illinois and Minnesota run mature Medicaid MCO markets. Kansas stays in the non-expansion ten.
Southwest & Mountain
MACs: Novitas JH (TX, OK, AR, LA, NM, CO) · Noridian JE (NV) · Noridian JF (AZ, UT, MT, ID, WY)
The reform belt: Texas gold-carding (HB 3812, eff. Sept 1, 2026) and its telehealth coverage mandate (HB 1052, eff. Jan 1, 2026), plus Louisiana’s gold-card law. Texas is also a non-expansion state with prompt-pay penalties that actually bite. The JH contract was re-awarded to Novitas June 24, 2026 — same seven states.
West & Pacific
MACs: Noridian JE (CA, HI) · Noridian JF (OR, WA, AK)
Medi-Cal — the nation’s largest state Medicaid program — plus Oregon’s coordinated care model, Washington’s managed Apple Health, and Hawaii’s Med-QUEST. All expansion states with deep Medicaid books. California remains the notable PSYPACT hold-out alongside New York.
Territories & special cases
Practices billing Puerto Rico and the U.S. Virgin Islands route through the First Coast (JN) territory; American Samoa, Guam, and the Northern Marianas through Noridian JE. DMEPOS suppliers run on a separate four-jurisdiction DME MAC map regardless of location. If your footprint is unusual, that’s a mapping exercise we run in the first week — not a reason to say no.
The State Reform Layer — Where You Practice Decides Which Relief Applies
Prior-authorization relief now comes in three layers, and your state plus your payer mix decide which ones you can invoke. We track all three, per payer, per practice — and we chase the exemptions, because they don’t apply themselves.
🏛️ State gold-card laws
Texas HB 3812 — effective September 1, 2026: a one-year lookback, at least 5 prior-auth requests for a given service, and at least 90% approval earns exemption from preauthorization for that service. Louisiana, Michigan, Vermont, and West Virginia have passed comparable laws. State by state, this is real workload that disappears.
🏥 National payer programs
UnitedHealthcare has run a national gold-card-style program since October 1, 2024 — around 92% approval over two years earns program relief, though advance notice is still required. Payer programs apply everywhere a plan operates, which makes them the fastest layer to activate — when someone tracks the thresholds.
⚖️ The federal floor
CMS’s interoperability rule (CMS-0057-F) since January 1, 2026: 72-hour expedited and 7-day standard prior-auth decisions, with specific denial reasons — for Medicare Advantage, Medicaid, and CHIP (not traditional Medicare fee-for-service, which doesn’t require payer preauthorization the same way). National, enforceable, and only useful when deadlines are actually held to.
The punchline
Two practices performing identical services can face wildly different prior-auth burdens purely because of their state and their payer mix. The full discipline — thresholds tracked, exemption status chased, 72-hour clocks enforced, appeal rights exercised — is laid out on our Prior Authorization & Eligibility page.
Multi-State and Telehealth Practices — One Matrix Instead of Five Vendors
The fastest-growing practice type is the one that outgrew its state line. The moment your patients span states, your billing runs on a matrix — clinician × license × state × payer × enrollment — and nobody maintains a matrix they don’t know exists.
Licensure & compacts
Who can legally see whom, where. PSYPACT now spans 42+ jurisdictions (Montana joined October 2025), but California and New York remain outside — so a telepsych practice’s coverage map has real holes a compact won’t fill. We maintain the license-coverage matrix so growth decisions come with a map, not a surprise.
Per-state enrollment
Every state line means its own Medicaid enrollment, its own commercial participations, its own carve-outs — the full discipline lives on our Credentialing & Enrollment page, included with RCM rather than billed as the industry’s favorite add-on.
Prescribing rules & dates
The DEA telemedicine flexibility for controlled substances runs through December 31, 2026 — a cliff every telepsych and weight-management practice should have on a calendar with a plan attached. We flag rule changes per state before they flag you.
The alternative, honestly described
One vendor per state — five states, five contracts, five denial taxonomies, five sets of KPI definitions that never reconcile, and nobody who can see the whole patient journey. The matrix isn’t a luxury for multi-state practices; it’s the difference between a practice and a federation of confusions.
What We Verify Before We Quote You — Eight State-Diligence Checks
Our onboarding runs two to three weeks in every state, and it starts with the same eight checks — the state-specific work most companies do never, and bill for later as “cleanup.”
Your MAC & LCD exposure
Your jurisdiction’s LCDs and billing articles screened against your top 20 codes — the first-pass rejection risks mapped before claim one.
Your Medicaid program
The filing limit, the MCO list and their individual rules, carve-out routing, and enrollment status per provider.
Your prompt-pay statute
The windows (typically ~30 days electronic / ~45 paper), the interest rate, and the escalation path to your state insurance department.
Your PA-reform eligibility
Gold-card status by state law and by payer program; the CMS 72-hour/7-day clocks applied to the plans actually in your mix.
Your telehealth rules
Coverage and payment parity status for your virtual visit mix — 44 jurisdictions regulate it, only about half mandate true parity.
Your licensure coverage
Compact membership, per-state licenses, and the enrollment matrix that has to follow them — the growth map.
Your WC & no-fault exposure
Volume, portals, monopolistic state funds, and no-fault filing windows — the claim families others exclude.
Your expansion reality
Expansion status and payer mix — the honest picture of your self-pay exposure and patient-payment discipline needs.
Rule load & data pull. The eight checks above, your payer mix mapped, historical claims extracted and baselined — KPIs computed so improvement is provable from month one.
Cutover. Clearinghouse connection established, enrollments and reassignments verified, denial-rule baselines documented, fee schedules loaded.
Live, measured. Claims flowing under the full discipline — and the first report against the same KPI targets we publish on this page.
What Other “States We Serve” Pages Give You — What This One Runs On
| Dimension | The typical state page | RevGen, in your state |
|---|---|---|
| The coverage claim | “We serve all 50 states!” next to a stock US map | All 50 + DC on a rule matrix: MAC, Medicaid program, prompt-pay, parity, expansion status — demonstrated above |
| Medicare detail | None — Medicare treated as one national blob | Your MAC named, its LCDs checked against your top codes, jurisdiction transitions tracked |
| Medicaid detail | Your city’s name in a list | The program’s filing limit, the MCO list, carve-out routing, per-provider enrollment status |
| Prompt-pay law | Never mentioned | Windows tracked claim-by-claim, interest demanded where the statute pays it |
| Prior-auth reform | Absent or years stale | Gold-card laws with effective dates, national payer programs, CMS-0057-F clocks — current for 2026 |
| Telehealth | “We do telehealth billing” | The 44-jurisdiction parity picture, PSYPACT coverage map, DEA dates — the actual rules |
| Multi-state story | “Clients everywhere” — unverifiable | The licensure–enrollment matrix described in full, with the work it implies |
| Standards | Vague quality claims that vary by office | Same KPI targets and formulas in every state — first-pass ≥95%, net collection ≥96%, A/R <35 days |
| Proof of currency | None | Named sources and dates throughout, with the program references consolidated in the footer |
🧮 KPI 1
First-pass rate
Claims paid on first submission ÷ claims submitted
Target: ≥95%
🧮 KPI 2
Net collection rate
Payments ÷ collectible dollars
Target: ≥96%
🧮 KPI 3
Days in A/R
Average days from service to payment
Target: <35
🧮 KPI 4
Denial rate
Claims denied ÷ claims submitted
Target: <5%
Geography changes the rules, not the standards
The layers in this page — MAC, Medicaid, prompt-pay, parity — change how the work is done in your state. They never change what good looks like: the four targets above, with their formulas, reported identically everywhere we practice. The full cycle they sit inside is on our Revenue Cycle Management and Denial Management pages.
Where This Fits in the System
Your state’s rules are the environment; this is the machine that runs inside it:
Frequently Asked Questions
The questions practices ask about nationwide billing — answered with jurisdictions, statutes, and dates instead of reassurance. (This FAQ also ships with structured schema markup for search visibility.)
Do you provide medical billing services in all 50 states?
Does my billing company need an office in my state?
What is a Medicare MAC and why does mine matter?
Do you know my state’s Medicaid rules?
My state has a prompt-pay law — does that actually help us get paid?
Does the new prior authorization reform apply in my state?
Can you support a telehealth practice that treats patients in multiple states?
Do you handle workers’ comp and auto no-fault claims?
How is a national billing company different from a local one?
How quickly can you onboard a practice in a new state?
Can you enroll our providers with our state’s Medicaid program?
What will the free audit tell me about how my state’s rules affect us?
Wherever You Practice, Find Out What Your State’s Rules Are Doing to Your Revenue
The free audit is state-aware: your MAC’s LCD exposure on your top codes, your filing discipline against your Medicaid program’s limits, payer lag against your prompt-pay statute, parity status for your telehealth mix — and KPI baselines against published targets.
Request Your Free Audit →✔ Findings in 24–48 hours · ✔ No obligation · ✔ All 50 states + DC, one accountable team