Medicaid Claims Billing lets communities bill Medicaid payers by electronic claim instead of by invoice. ALIS tracks each resident's billable service days, generates the 837I claim file, and records the payer's remittance against those claims. This guide gives an overview of the enablement requirements and the claims billing cycle.
About Medicaid Claims Billing
Claims-billed payer types work differently from invoice-based payer types. ALIS adds each resident's service days to the Billing Queue every night and posts that revenue to the general ledger as it accrues, before a claim is sent.
When you're ready to bill, you export the queued days as a claim batch and upload the file to your payer or clearinghouse. When the payer pays, you upload its remittance (835) to mark the claims paid and clear the receivable.
Note: ALIS does not send claim files or receive remittances directly. You transfer files through your payer's portal or your clearinghouse.
Enablement Requirements
Medicaid Billing is behind an entitlement and requires the ALIS team to enable it for your company. To have it enabled, contact your Account Manager or the ALIS Customer Support Team.
Before your first export, confirm the following are in place:
- Medicaid Billing Entitlement & Security Role Permissions: Enabled for your company by the ALIS team.
- GL integration: Enabled for your company. See How to Enable Your GL Integration.
- Payer enrollment: The payer's companion guide or clearinghouse enrollment, which supplies your Payer ID, Receiver ID, Submitter ID, and required codes.
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Payer type: A payer type that uses the Claims generating method, with Claim Submission Details completed on its Billing Program and a Leave billing rule that matches your payer’s requirements:
- Exclude only days away the whole day (default): departure and return days are billed.
- Exclude every day a leave touches: departure and return days are not billed.
- GL accounts: Accounts Receivable, Revenue, and Primary Deposit accounts mapped for the claims payer type.
- Billing items: A procedure code, qualifier, and any claim modifiers on each billed service.
- Community Details: The community address and a valid 10-digit billing contact phone number.
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Resident Profile:
- Basic Information (Birth Date, Sex at Birth, Medical Record #)
- An active, primary Insurance Information record with a Subscriber #
- Physician contact with an NPI
- A claims-specific Recurring Charge linked to the resident’s Medicaid insurance
For setup steps, see How to Set Up Medicaid Claims Billing.
Access Medicaid Claims Billing
Once enabled, claims work happens on the Medicaid Billing page:
- Enhanced Navigation (sidebar): Billing → Resident Billing → Medicaid Billing
- Legacy Navigation (top menu): Billing → Medicaid Billing
Pictured: Enhanced Navigation
The Claims Billing Cycle
- Set up claims billing: Configure the payer type, billing items, community, and residents. See How to Set Up Medicaid Claims Billing.
- Service days accrue: Each night, ALIS adds service days to the Billing Queue and posts the revenue to the general ledger. See How Medicaid Claim Charges Post to the General Ledger (Link Coming Soon).
- Hold charges (optional): Keep a resident's days out of the Billing Queue while paperwork or an authorization is pending. See How to Hold and Release Medicaid Claims.
- Generate and export claims: Select queued days, export a batch, and upload the 837I file to your payer or clearinghouse. See How to Generate Claims and Correct Rejected or Denied Claims.
- Handle rejections: Remove a rejected claim from its batch, correct the data, and export it again. See How to Generate Claims and Correct Rejected or Denied Claims.
- Releasing soon. Post the payment: Upload the payer's 835, review it, and save it to mark claims paid and post the payment to the general ledger. See How to Post a Clean 835 Payment (Link Coming Soon) and How Medicaid Claim Payments Post to the General Ledger (Link Coming Soon).
- Monitor balances: Track unsubmitted charges and aging claims on the Aging Report. See How Claim Balances Appear on the Aging Report (Link Coming Soon).
Medicaid Claims Billing Glossary
To view key terms related to the claims process, where the value comes from, and where you enter them see Medicaid Claims Billing Glossary.