10/06/2025
Update on Webportal/Claim Issues from Oct 2
What Happened:
On Thursday, October 2, Gainwell published a notice on the web portal stating that there were system issues causing some claims to go into suspended status.
This impacted all submissions, whether entered manually or via direct upload.
Late Friday, Gainwell issued an update confirming that the issue was resolved. However, they noted that:
• Remittance vouchers would not be posted until Monday, October 6, and
• Claims in suspended status would not process for payment this week but would instead process next week (October 16).
Normally, claims are suspended due to recipient eligibility or provider issues; however the issues last week were unrelated. AHCA has yet to send out an Alert for official clarification on the root cause. Frustratingly, some claims were affected while others processed normally.
What This Means for You
Because of the suspended claims, payment amounts will vary this week:
• Some providers may receive partial payment, while
• Others may receive no payment at all if all claims were suspended.
It is recommended that providers print this week’s remittance voucher to verify payments. Suspended claims should process for payment next week.
Billing Reminders
To help minimize future delays:
• Submit billing as early in the week as possible.
Per AHCA’s contract with Gainwell, claims received by Wednesday at midnight are processed for the following week’s payment.
While about 95% of claims received as late as Friday at 7 PM still process and pay the following week, this is not guaranteed.
Events like this demonstrate the importance of submitting billing timely.
Bottom line:
If you absolutely need to ensure payment for the following week, submit your billing by Wednesday at Midnight.
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