Each claim you export from ALIS appears on the resident's profile, on a Claims tab next to their invoices. Review one resident's private pay invoices and Medicaid claims in one place, without the two mixing, and see whether each claim is waiting for payment, paid, or denied. This guide covers finding a resident's claims and reading each claim's status.
Note: Values and examples in this guide follow California Medi-Cal requirements.
Step 1: Open the Resident’s Claims
Start on the resident’s profile.
- Open Residents from your navigation menu:
- Enhanced Navigation (sidebar): Residents
- Legacy Navigation (top menu): Residents > All Residents
- Open the resident’s profile, then open their Billing section.
- Expand Invoices & Claims, and click the Claims tab.
Step 2: Find and Review a Claim
Use the filters and columns to find a claim and see where it stands.
- (Optional) Click Pending, Paid, or Denied to filter the list, or type a claim number in Search claims.
- Find the claim, and read its Status.
- (Optional) Click Options > View Batch Details to see the batch the claim was exported in.
Tips:
- CN: [#] is the payer’s claim control number. It reads CN: pending until a payment is saved. Search claims finds both ALIS claim numbers and CNs.
- Linked RA downloads the 835 that answered the claim.
- The blue banner shows service days not yet on a claim. Click Open Billing Queue to bill them.
Claim Statuses
| Status | What it means |
|---|---|
| Pending |
Exported, with no payment saved yet. Note: For processing status or payment timing, check your clearinghouse or the payer's portal. |
| Paid | Paid in full on a saved 835. |
| Partially Paid | The payer paid less than billed. |
| Overpaid | The payer paid more than billed. |
| Not Fully Reconciled | Part of the payment couldn’t be matched to a billed day. |
| Denied | The payer processed the claim and paid nothing. |
| Voided | A denied claim that was voided. Its days returned to the Billing Queue. The status shows who voided it, when, and the reason. |
Tip: Pending means the claim was exported and no 835 has been saved for it yet. ALIS doesn't receive processing updates from your clearinghouse or payer, so a claim that's still processing and a claim that was rejected both show Pending. To see where a claim is in processing, who it's pending with, or when to expect payment, check your clearinghouse or the payer's portal. If it was rejected, see How to Generate Claims and Correct Rejected or Denied Claims.
The Paid and Denied filters show only those exact statuses. To see partially paid, overpaid, not fully reconciled, or voided claims, use All Claims.