Use Hold from Billing when a resident is receiving Medicaid services that cannot be billed yet, such as while waiver paperwork is pending or an authorization number hasn’t arrived. This guide covers placing a hold, reviewing holds on the Bill Hold Report, and releasing a hold.
Note: Values and examples in this guide follow California Medi-Cal requirements.
About Holds
A hold covers the gap between when a resident starts receiving Medicaid services and when the community is allowed to bill for them. Common reasons for a hold include pending waiver enrollment, a missing authorization, or a pending tier change.
While a charge is on hold:
- Service days accrue. Service days stay out of the Billing Queue but keep accruing. When you release the hold, every unbilled day on the charge moves into the Billing Queue so you can bill it on your next claim.
- Days already on a claim are unaffected. A hold only keeps days that have not yet been exported off future claims.
- Revenue is still recorded. Held days post to the general ledger every night, so the Unsubmitted amount on the Aging Report grows during a long hold. This is expected. See How Medicaid Claim Charges Post to the General Ledger.
- Holds are tracked in reporting. The Bill Hold report shows every held charge, how long it has been held, and how much is waiting to be billed. See the Bill Hold Report section below.
Step 1: Place a Charge on Hold
Place the hold as soon as you know a resident’s days can’t be billed yet, and always before your next claim export. Days exported before the hold is placed are already billed.
To place a charge on hold:
- Open Residents from your navigation menu:
- Enhanced Navigation (sidebar): Residents.
- Legacy Navigation (top menu): Residents > All Residents.
- Scroll down to Billing, and expand Recurring Charges.
- On the claims recurring charge, click Options > Edit Charge.
- Check Hold from Billing.
- Click Submit.
The charge’s Status changes to On Hold, and its unbilled service days appear on the Bill Hold Report instead of the Billing Queue:
Tip: You can place a hold before the charge’s service period starts, such as when a resident’s move-in is scheduled but their waiver paperwork is still pending. Check Hold from Billing when you add the charge with a future Service Start date. The report shows the charge with a FUTURE badge and 0 days on hold until the service period begins.
Step 2: Release the Hold
When the pending paperwork or authorization comes through, release the hold from the Resident Profile. You cannot release a hold from the report, so you always see the full charge before you change it.
- Open the resident’s Recurring Charges:
- From the Bill Hold Report, click the resident’s name.
- Or, from the Resident Profile, expand Recurring Charges.
- On the held charge, click Options > Edit Charge.
- Uncheck Hold from Billing.
- Click Submit.
After submitting, the charge leaves the Bill Hold Report. Every unbilled day on the charge moves into the Billing Queue, back to the first day not yet on a claim. This is usually the service start, not the date the hold was placed.
Tip: If the payer’s authorization has a start date, some released days may not be billable. Before you export, adjust the Service Date Range in the Billing Queue to include only authorized days.
See Step 1 of How to Generate Claims and Correct Rejected or Denied Claims.
Bill Hold Report
Use the Bill Hold Report to see every held charge and which holds are putting timely filing at risk. Go to Reports > Billing Reports > Bill Hold.
Summary
The summary at the top shows Charges on hold, Units accrued, Held value, and Avg days on hold. It covers every charge that matches your filters, not just the current page.
Report Columns
- Resident: name and room. Click the name to open their Recurring Charges.
- Payer: the claims payer type.
- Held Charge: the billing item and description.
- Service Dates: the charge’s full service period, from start to end (“Ongoing” if there’s no end date), with the hold date and who placed it underneath.
- Units: every unbilled day on the charge, including days before the hold was placed.
- Est. Value: the unbilled value, with the daily rate shown as $X/day.
- Time On Hold: days on hold. The oldest holds are listed first.
Filter and Export
Use the filters at the top of the report:
- Time On Hold: All, Under 30 days, 30 – 59 days, or 60+ days.
- Payer, Resident, and Billing Item: searchable lists.
- Service Dates: leaves out charges outside the dates you choose.
To download, click Print Report or Export to Excel. Exports include only the filtered rows and list the filters used at the top.
Tip: If a resident is missing from the Billing Queue, check the Bill Hold Report first. A held charge is one of the most common reasons.
Key Terms and States
These labels appear on the resident’s Recurring Charges grid and the Bill Hold Report.
- On Hold: the charge’s status on the Recurring Charges grid while Hold from Billing is checked.
- Days accrued: shown under the charge name on the Recurring Charges grid. The number of unbilled service days on the charge and their value, counted from the service start or the last day already on a claim. Includes days before the hold was placed.
- Time On Hold: on the report, the days on hold, counted from the date the hold was placed or the charge’s service start, whichever is later.
- Time On Hold (Amber): the charge has been on hold 30 days or more.
- Time On Hold (Red): the charge has been on hold 60 days or more.
- FUTURE: the hold was placed before the charge’s service period started. Shows 0 days on hold.
- Unknown: the hold was placed before ALIS started recording hold dates. The charge is still on hold.
How holds behave when a charge changes
| Action | Hold Impact |
|---|---|
| Edit a held charge without releasing it (for example, change its description) | The hold stays, and its hold date and days on hold don’t reset. |
| Change the rate on one resident’s held charge | The new charge keeps the hold and the original hold date. |
| Use a bulk rate change or a rate change import | The new charge keeps the hold, the original hold date, and who placed it. |
| End a held charge | It stays on the report until all of its held days are released or removed. |
| Delete a held charge | Its unbilled days are removed and it leaves the report. Days already on a claim aren’t affected. |
Troubleshooting
| Issue / Situation | Troubleshooting Step |
|---|---|
| Time On Hold reads Unknown | No action needed. The charge is still on hold. Unknown holds are listed first and only appear under the All filter. |
A charge shows FUTURE and 0 days |
No action needed. The charge’s service period hasn’t started yet. |
| Units or days accrued are higher than Time On Hold | No action needed. Units count every unbilled day since the service start, including days before the hold was placed. Time On Hold counts only from the hold date. |
| A released charge’s days aren’t in the Billing Queue | Click Sync now on the Billing Queue, and widen the Service Date Range to cover the held period. |
| Days in the Billing Queue show a Voided badge | These days didn’t come from a released hold. They came back from a claim that was voided after the payer denied it in full. See How to Generate Claims and Correct Rejected or Denied Claims. |