How to Troubleshoot Claim Submission Errors

Learn why a claim submission might fail after a session scheduled on the Alma Calendar, and how to resubmit it once the issue is resolved.

Why Can't I Submit My Claim?

You may see a draft claim in the Ready to Bill section of your Billing tab but be unable to complete submission, for one of two reasons.

Your Client's Eligibility Has Not Been Confirmed Yet

If Alma is still running an eligibility check for your client, you cannot submit a claim yet. You see this error message: "We're still confirming your client's insurance eligibility. Please cancel this action for now and return once the eligibility check is complete." Wait until the eligibility check finishes before submitting.

Your Client's Insurance Status Changed to Out-of-Network

Every appointment on the Alma Calendar links to an active eligibility check, so we can confirm your client's ongoing coverage as you book appointments.

If we finds an issue with your client's insurance, such as a lapse in coverage, after you create the appointment, their plan may no longer be in-network. In this case, you and your client need to negotiate a private-pay rate and payment method for future sessions until they have active insurance with a plan Alma is in-network with.

Alma emails you and your client to explain that we could not verify their insurance and why.

If Alma is out-of-network with your client's plan, we pause the submission of any claims in with the Ready to Bill status until we verify your client's insurance again. This step protects your client from unexpected charges; it does not affect their ability to receive care.

Note: In some cases, Alma needs to work directly with your client's insurance payer to resolve these issues. Your client may receive an Explanation of Benefits (EOB) showing a denied claim in the meantime, though their benefits still show as eligible in the Alma Portal. Alma follows up with you and your client once more information arrives from the payer.

What to Do About a Blocked Claim

If your client has valid insurance details that just need updating in the portal, send them a link to update their information. See: Add Insurance & Payment Details.
Reach out to your client directly to discuss payment options going forward.
If your client no longer has insurance coverage, discuss options for continuing care out-of-pocket.

Once you and your client update their insurance details and Alma verifies their eligibility as in-network again, you can resubmit your claim for the previous session.

How to Resubmit a Blocked Claim

Go to the Billing tab and select Ready to Bill.
Select the draft claim for the date of service you were unable to submit.
Select Remove Claim.
Confirm by selecting Yes, Remove Claim. Alma deletes the claim from Ready to Bill.
Select + Create New > Insurance Claim, in the upper-left corner of the Billing tab.
Select the client's name, enter the appointment date and state of service, and select the relevant CPT code(s), modifier(s), and ICD-10 code(s).
Select Send to Alma.