How to Adjust a Submitted Claim in ElderSuite

This article shows how to correct or void a claim after ElderSuite has already submitted it. When you finish, you will know when to use Replacement versus Void, where to enter the payer's claim number, and how to send the adjusted claim through Process Claims.

Confirm whether the payer accepted the original

Before you change a resubmission setting, open Claim Center → View Reports → Billing Reports. Open a 277 / 277CA claim status response or an ERA / 835 in the detail viewer. Whether the payer ever accepted the claim decides which Resubmission Code to use.

If the clearinghouse or the payer's front end rejected the claim before adjudication, the payer has no claim on file. Leave Resubmission Code blank or set it to Original, correct the data, and send it again. Do not invent a reference number.

If the claim was accepted and adjudicated—paid or denied—the payer issued a claim number. That is when Replacement (a corrected claim) or Void applies. If the claim shows accepted but the payer has no record and no claim number, follow up with the payer before resubmitting.

Fix the cause where it lives

Correct the underlying record first. Scrub Claims copies values from the client onto Pending claims. If Claim Setup, the payment type, or the client record is still wrong, a scrub can put the wrong value back.

For date of service, units, and charges that come from attendance, correct the attendance record. Those values are read-only on the claim or recalculated from the times.

Set the claim status to Pending

Process Claims only picks up claims whose status is Pending and that are free of scrub errors. Scrub & Fix also skips non-Pending claims.

On one claim, open the Health Insurance Claim Form and set Claim Status at the top-right of the claim body to Pending.

For several claims at once, open Claim Center → Reconcile Claims, check the rows, click Change to..., select Pending, click Change, then Save & Close. How to Reconcile Claims in ElderSuite covers that screen.

Open the claim and choose Replacement or Void

From Claim Center → Scrub Claims, set the service date range, click Find, highlight the claim, and click Edit Claim (or double-click the row). The Health Insurance Claim Form opens.

On item 22, use the Resubmission Code dropdown:

• Replacement — ElderSuite submits the claim as a replacement for the prior claim (the corrected-claim choice).
• Void — ElderSuite submits the claim as voided for the prior claim. Confirm first that your payer accepts electronic voids; some require a portal or paper form instead.
• Original or blank — for a claim that never reached adjudication.

The blue circled-i beside the dropdown opens a short help window that explains the three choices. Close it with Ok or Enter.

ElderSuite builds the electronic 837P from the choice you pick and attaches the original claim number when you select Replacement or Void. You choose the named option on the form; you do not type a numeric frequency code.

Enter Original Reference No.

When Resubmission Code is Replacement or Void, Original Reference No. (item 22, beside the dropdown, up to 25 characters) is required. It holds the payer's claim number for the original submission—also called the Payer Claim Control Number or claim ID on reports. Click into the box to type; Tab skips it. If you leave it empty, the box turns gold and the claim is flagged.

Find the number on clearinghouse reports: Claim Center → View Reports → Billing Reports, then open a 277 / 277CA or ERA / 835 and read the Claim Number column (Payer Control Number and Reference Code may also appear). After you download a report, Auto Reconcile can write the payer's claim number onto matching attendance records, which often fills this field for you.

Do not use a clearinghouse trace number or a made-up value just to clear the gold highlight. If there is no payer claim number, do not send the claim as Replacement or Void.

Make any other editable corrections on the form, then click Save & Close. Saving does not transmit the claim.

Scrub, then Process Claims

1. Open Claim Center → Scrub Claims.
2. Set the date range, click Find, then Scrub & Fix.
3. Confirm the error flag in the narrow first column is clear for the claim.
4. Click Save & Close.
5. Open Claim Center → Process Claims and work through the wizard (clearing house, payer, service date range, clients), then Process.

How to Process Claims in ElderSuite walks through that wizard. After the next report cycle, review Billing Reports and record the outcome with Auto Reconcile or Reconcile Claims.

Timing and filing limits

Adjustment windows and filing limits are payer rules, not ElderSuite settings. Confirm the deadline with your payer or clearinghouse before you resubmit. If you bill Texas Medicaid through TMHP, see the 95-day filing guidance on Texas Medicaid DAHS Rates and Billing.

The broader billing path from attendance through submission is on Adult Day Care Billing Software.

Troubleshooting

• Original Reference No. turned gold. Resubmission Code is Replacement or Void and the box is empty. Enter the payer's claim number, or set the code back to Original / blank if the claim never reached adjudication.
• Corrected claims come back as duplicates. Confirm Replacement plus the correct Original Reference No. A correction sent as Original looks like a duplicate. If both are right, many MCOs still require their portal or paper instead of an adjusted 837P—confirm with the payer.
• I cannot find a numeric code 7 or 8 on the form. ElderSuite shows named choices only—Original, Replacement, and Void. Pick the name that matches what the payer asked for.
• I need a refund or takeback. Do not key a negative charge. Follow the payer's refund procedure, and use Void only if the payer instructs you to.
• The printed claim leaves Box 22 blank. Expected. The resubmission code and original reference are for the electronic file, not the printed form. If the payer needs paper, mark Box 22 yourself or use their portal.
• Need help finding a screen. Use ElderSuite Support (+1 888.999.8055, support@eldersuite.com).

Still stuck? Open a support ticket. Include the payer name, whether the original was rejected before adjudication or accepted, the Resubmission Code you used, and whether Original Reference No. matched the report Claim Number.

Once the adjusted claim is sent, keep watching Billing Reports and reconcile the new status. Related reading: Adult Day Care Claim Denials.