Skip to content
  • There are no suggestions because the search field is empty.

Medicaid Claims Submission Guide

 Streamline your Medicaid claims submission process directly through Residex—no need to visit multiple clearinghouse portals for different payers! Through our partnership with Waystar, when you contract with Waystar, Residex offers integrated claims submission that allows you to manage all your Medicaid claims from one central location, saving your billing staff significant time and effort.

Table of Contents:

Create a Claims Batch
Claims Status Tracking

Creating a Claims Batch

  1. Navigate to the Billing > Process Billing tab
  2. Select the Claims tab
  3. Click + Create a batch

 

Selecting Claims for Submission

  1. Choose your payer from the dropdown menu
  2. Residex will automatically populate a list of residents associated with that payer
  3. Select your submission dates

Pre-Validation Process

Before submitting your claims, Residex performs a critical pre-validation check to ensure accuracy.

What Pre-Validation Does

The pre-validation step reviews all residents (selected) in the batch and checks for discrepancies between:

  • What was charged
  • What will be submitted (accounting for Hold days)

Pre-Validation Results

Success: If no issues are found, you'll see the message "Pre-Validation passed" and can proceed with submission.

Error: If discrepancies exist, you'll receive an error message explaining exactly what needs to be corrected before you can submit.

 

Claim Status Tracking

Residex provides real-time status updates at every stage of the claims process, saving your billing staff significant time and effort.

Status Messages

🗒️ Each payer may display slightly different messaging about claim status.

Processing/Pending (highlighted yellow)

The payer has received the claims and is processing them.

Paid / Paid with Adjustments / Spend downs (highlighted green)

Rejected / Failed (highlighted red)

Means there are errors in the batch

Accepted (highlighted blue)

Means no problems in the batch but no further updates on payment status

Each payer will display a number to reflect how many claims are in that batch.

Use the drop down arrow to see the claims in the batch

Click on the resident name to view the status of the claim. It will look similar to this:

 

You can scroll down to see the history of "responses" for the claim