ALIS adds each resident’s claim-billed service days to the Billing Queue every night. When you’re ready to bill, you export them as a claim batch and upload the 837I file to the payer or clearinghouse. This guide covers reviewing the Billing Queue, exporting claims, finding exported batches, and correcting a claim the payer rejected or denied.
Note: Values and examples in this guide follow California Medi-Cal requirements.
Before You Begin
- Claims setup: The community’s claims setup must be complete. See How to Set Up Medicaid Claims Billing.
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Resident leaves: Enter any leave of absence, such as a hospital stay, before you export. Include its end date when the resident returns.
- Leave days are left off according to the payer type’s Leave billing rule. The default, Exclude only days away the whole day, bills departure and return days.
- A leave entered late for days still in the Billing Queue removes those days automatically.
- A leave entered after its days were exported doesn’t change the exported claim. Remove the claim and export it again; see Remove a Rejected Claim (Return to Queue).
- Held charges: Days on a charge with Hold from Billing checked stay out of the Billing Queue until the hold is released. See How to Hold and Release Medicaid Claims.
Step 1: Review the Billing Queue
Start on the Medicaid Billing page.
- Open Medicaid Billing from your navigation menu:
- Enhanced Navigation (sidebar): Billing > Resident Billing > Medicaid Billing
- Legacy Navigation (top menu): Billing > Medicaid Billing
- The Billing Queue tab opens by default. Set the Service Date Range.
- (Optional): Narrow the list with the Community, Payer Type, Procedure Code or Resident filters. The Procedure Code list only shows codes that exist for your current filters.
- Review each row: resident and room, service, service dates, days and amount.
- If a row shows a modified badge, click it to see which days were left off and why.
Tip: Click Sync now in the top right corner to add service days that accrued since the last nightly run.
If a resident is missing from the Billing Queue, check the Bill Hold Report (Reports > Billing Reports > Bill Hold). A held charge is one of the most common reasons.
Step 2: Select the service days to bill
Choose which rows go on this batch.
- Check the box on each row you want to bill, or check the box at the top of the list to select all rows. The number of rows selected and their total appear next to it.
How your selection becomes grouped claims:
- Same resident, more than one procedure code: both go on one claim as separate service lines.
- More than one payer type: ALIS creates one file per payer type and tells you in the Export Claims window.
Tip: To send each procedure code on its own claim, filter the queue to one Procedure Code, select its rows and export. Repeat for the next code.
Step 3: Export the claims
Create the batch and download the claim file.
- Click Export Claims.
- In the Export Claims window, review the Service Date Range, number of Claims and Total Amount.
- Enter a Batch name. It’s required, and can use letters, digits, underscores and hyphens, up to 40 characters. (For example: SunshineSL_2026_10.)
- Click Download. ALIS creates the batch and downloads the 837I claim file (.txt format).
Important: After downloading the file, upload the file to the payer’s portal or your clearinghouse. ALIS does not send the file for you.
The batch appears on the Export tab, and its days leave the Billing Queue. The Audit tab records who exported the batch, the number of claims, the total and the service date range.
Step 4: Find and review an exported batch
Use the Export tab to review a batch or download its file again. Each batch row shows the batch number, date generated, number of claims, billed amount, paid amount and any linked remittance (RA Linked).
- Select the Export tab.
- Find the batch with the Date Generated, Batch, Community or Procedure Code filters.
- Click View Details to see each resident’s claim in the batch.
- (Optional): To download the file again, click the gear icon on the batch row and select Download file.
Tip: The batch number in ALIS matches the one in the claim file name and inside the file. If a payer or clearinghouse gives you a batch number, enter it in the Batch filter.
You can also see a resident’s claims on their profile: Billing section > Invoices & Claims > Claims tab. See How to Check a Resident's Medicaid Claims Status.
If a Claim is Rejected or Denied
Most claims need no follow-up. Use this section only if your clearinghouse or payer rejects a claim, or an 835 shows a claim was denied. First, check which one it is:
| Rejected | Denied | |
|---|---|---|
| What happened | The clearinghouse or payer refused the claim before processing it, usually because of missing or invalid data. | The payer processed the claim and paid nothing. |
| How you find out | Your clearinghouse or payer portal’s rejection report. No 835 comes back. ALIS has no Rejected status. | An uploaded 835 shows the claim as Denied on the Reconcile Remittance page. |
| What to do | See Remove a Rejected Claim (Return to Queue. | See Void a Denied Claim. |
| Allowed when | Before any 835 for the claim is uploaded. | After a saved 835 denies every day of the claim with nothing paid. |
Remove a Rejected Claim (Return to Queue)
- On the Export tab, find the batch and click View Details.
- Next to the rejected claim, click Return to Queue.
- In Remove claim from batch?, click Remove claim.
The claim’s days return to the Billing Queue, the batch’s claim count and total go down, and the Audit tab records the removal. If you remove the last claim in a batch, ALIS deletes the batch.
To delete a whole batch (for example, if the entire file was rejected):
- On the Export tab, click the gear icon on the batch row and select Delete.
- Click Delete batch to confirm. All of the batch’s claims return to the Billing Queue.
Important: Only remove claims the payer rejected or that were never submitted. Re-exporting creates a new original claim, so if the payer already accepted the first one, the new claim is a duplicate.
You can’t remove a claim or delete its batch once a payer has responded, including a remittance (835) that’s uploaded but not yet saved. The confirmation shows the reason and the remittance file, and the button is disabled.
Void a Denied Claim
Voiding records the denial in ALIS and returns the claim’s days to the Billing Queue, so you can fix and bill them again. Nothing is sent to the payer.
Before you void, save the remittance. See How to Post a Clean Medicaid Payment (835/ERA).
- On the Medicaid Billing page, select the Export tab.
- Find the batch, and in the RA Linked column, click the remittance file name. The saved Reconcile Remittance page opens.
- Find the claim with the Denied status, and click Void.
- In the Void Claim pane, review the Resident, Medicaid ID, Claim Control Number, ALIS Claim #, services, and Denial codes.
- Enter a Void Reason (required, up to 500 characters).
- Click Void Claim.
Important: A void can’t be undone. Do not void a claim you plan to appeal.
After you void:
- The claim shows Voided on the Reconcile Remittance page and the resident’s Claims tab, with who voided it, when, and the reason.
- Its days return to the Billing Queue, labeled From a void with the original claim number and void date. They bill at the rate in effect on each day, which may differ from what was billed.
- Correct whatever caused the denial (see Common Rejection and Denial Causes), then select and export the days again (above Steps 2 and 3).
If Void is grayed out, the reason shows below it:
| Message | What to do |
|---|---|
| “This claim can’t be voided until it has a saved 835.” | Save the remittance first, then reopen it from the Export tab. |
| “An 835 for this claim has been uploaded but not saved. Save or delete it before voiding the claim.” | Open the unsaved 835 from the Export tab, and save or delete it. |
| “This claim can’t be voided: a saved 835 must deny every day on it with nothing paid.” | The payer paid part of the claim, so it can’t be voided. Follow your community’s process for partial payments. |
| “This claim has already been voided.” | No action needed. |
Example Message:
Common Rejection and Denial Causes
- Recipient Eligibility: the resident wasn’t covered on the service date. Check the insurance record’s coverage dates and Subscriber #.
- Provider Eligibility or Data Validity: incorrect Billing NPI, taxonomy code, facility type code, procedure code, or modifier. See Steps 2 and 3 of How to Set Up Medicaid Claims Billing.
- Other Coverage: the resident has other insurance that must be billed first. Check the insurance sequence.
- Duplicate Claim: the payer already has a claim for these service days.
Key Terms and States
| Term | What it means |
|---|---|
| Modified | The row has fewer billable days than the full period, usually because of a leave of absence (under the payer type’s leave billing rule) or an ended charge. Click the badge to see the dates and reason. |
| Rejected | The clearinghouse or payer refused the claim before processing it. Shown only in your clearinghouse or payer portal. |
| Denied | The payer processed the claim and paid nothing. Shown on the Reconcile Remittance page. |
| Return to Queue | Removes a rejected claim from its batch and returns its days to the Billing Queue. Not offered on a voided claim. |
| RA Linked | A remittance (835) is linked to the batch. |
| From a void | A Billing Queue label on days returned from a voided claim. They re-bill at the rate in effect on each day. |
| From a void | The status of a denied claim that was voided. Shown on the Reconcile Remittance page and the resident profile Claims tab. |