837P Claims for Adult Day Care Providers: A Plain-English Guide

An 837P is the professional electronic health-care claim transaction used for services billed on the professional-claim side of the health-care system. In an adult day care setting, whether 837P is the correct transaction depends on the payer and the service being billed.

In ElderSuite, staff do not type an 837P by hand. The electronic claim is built from the client, provider, payer, and daily service records already stored in the software. For the operating steps, see How to Process Claims in ElderSuite.

What an 837P represents

The 837P is the electronic professional-claim transaction commonly associated with the same class of billing information represented on a professional paper claim form. It carries structured data so a clearing house and payer can process the claim electronically.

For ElderSuite users, the important point is that the claim begins with the service record. Saving Attendance & Transportation Records for a client on a service date creates the associated Pending claim. ElderSuite calculates units from the recorded times and the client’s Payment Type rather than asking staff to type units into the electronic file.

What the electronic claim uses

The claim transaction draws from several parts of ElderSuite:

• Provider Information for the center’s billing-provider information and identifiers
• Client Information and Claim Setup for patient/subscriber information
• Payment Type for payer and billing defaults
• Attendance & Transportation Records for the service date and calculated units
• claim-specific fields when a payer requires items such as modifiers, authorization information, or resubmission data

The exact transaction content can vary by payer requirements. Do not assume that every payer uses the same optional fields simply because the transaction is an 837P.

How ElderSuite sends the transaction

Open the Claim Center and use Process Claims after the claims for the period have been reviewed. The wizard asks for the payer, clearing house, service dates, and clients. It gathers matching Pending claims that are not error-flagged, builds the electronic claim batch, and uploads it.

ElderSuite currently supports electronic submission through clearing houses named Availity and TMHP. Claims move to Submitted only after the upload succeeds. If the upload fails, they remain Pending.

The clearing-house route must match the payer. Traditional Texas Medicaid / DAHS fee-for-service claims use TMHP; payers that accept claims through Availity use the Availity route.

What is not an 837P

Export Claims creates a CSV working file from the claims listed in Scrub Claims. That CSV is not the electronic claim transaction sent through the clearing house.

The reports that come back are also different transactions. Acknowledgment and claim-status reports describe what happened after submission, while an ERA/835 is a remittance transaction. Those response files are not the 837P that was sent.

Why scrubbing still matters

Scrub & Fix reviews Pending claims, copies missing billing values from the client record where available, and flags unresolved issues. It cannot invent service units, a birth date, or an address.

How to Scrub Claims in ElderSuite covers that review step.

After the claim leaves

Download and review the available billing reports, then reconcile the result back to the same ElderSuite service record. How Auto Reconcile Updates Claim Statuses in ElderSuite explains the report-driven path.