How Auto Reconcile Updates Claim Statuses in ElderSuite
Learn how Auto Reconcile matches clearinghouse report data with ElderSuite records and automatically updates claim statuses, claim numbers, and audit notes.
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Auto Reconcile helps ElderSuite users update claim information from clearinghouse reports. Instead of manually reviewing and updating every matching record, Auto Reconcile processes the report, finds corresponding ElderSuite records, and applies eligible claim-status updates.
This reduces repetitive data entry while providing a clear summary of the records that were updated, skipped, or could not be processed.
Auto Reconcile is the reconciliation side of ElderSuite's broader billing workflow. See Adult Day Care Billing Software for the complete workflow from attendance through claims and reconciliation.
Where to Find Auto Reconcile
Go to Claim Center → View Reports.
Open the appropriate clearinghouse report in the Report Viewer, review its contents, and select Auto Reconcile.
Always verify that you have opened the correct report before starting. Auto Reconcile uses the information displayed in that report to locate and update matching ElderSuite records.
What Information Does Auto Reconcile Require?
Before processing begins, ElderSuite confirms that report data is available and checks for the required columns.
The report must contain:
- Insured ID
- Service Date
- Status
ElderSuite can also capture the Claim Number when that information is included in the report.
If the required information is missing, Auto Reconcile may be unable to process some or all of the report. ElderSuite displays the number of records that will be processed before making any updates.
How Records Are Matched
For each row in the clearinghouse report, ElderSuite reads the:
- Insured ID
- Service Date
- Reported claim status
- Claim number, when available
ElderSuite then searches for a matching attendance record using the Insured ID and Service Date. The report's Insured ID is matched to the insured ID saved in the client's Claim Setup.
Both pieces of information must identify the appropriate record. A missing or mismatched Insured ID or service date can prevent the record from being reconciled.
What Happens When a Match Is Found?
When ElderSuite finds an eligible matching record, Auto Reconcile can:
- Update the claim status using the status reported in the clearinghouse report
- Add or update the claim number when one is provided
- Create an audit note documenting the change
The audit note helps preserve a history of the automated update.
Finding a matching record does not always mean its status will be changed. ElderSuite applies status-transition protections before writing a new status.
Claim Status Transition Rules
Before changing a status, Auto Reconcile preserves two existing conditions:
- A Rejected claim is left unchanged. Rejected claims require review. Use Reconcile Claims to return the claim to Pending, make the needed corrections, and resubmit it.
- A claim already in a paid status is not moved out of the paid statuses.
Other eligible statuses can be updated from the report. For example, a later report can move a Denied claim to Paid when the payer reports payment.
When multiple report rows match the same Insured ID and Service Date, ElderSuite applies the highest-priority reported status. For example, a Paid result takes precedence over a Rejected result for the same matched record.
Reviewing the Completion Summary
After processing is complete, ElderSuite displays a summary showing:
- The total number of records processed
- The number of records successfully updated
- The number of records skipped
- The number of records that failed to update
Review this summary after every reconciliation. A completed process does not necessarily mean that every row was updated.
Why Might a Record Be Skipped?
A record may be skipped when:
- The Insured ID is missing
- The Insured ID does not match the insured ID in the client's Claim Setup
- The service date is missing
- The service date does not match an attendance record
- The claim status is missing
- The existing claim status does not permit the requested transition
- No corresponding ElderSuite record can be found
Skipped records should be reviewed individually. Compare the clearinghouse report with the client's claim and insurance information in ElderSuite to identify the mismatch.
Recommended Auto Reconcile Workflow
- Go to Claim Center → View Reports.
- Open the correct clearinghouse report.
- Review the report before processing it.
- Confirm that the report contains Insured ID, Service Date, and Status information.
- Select Auto Reconcile.
- Review the number of records ElderSuite is preparing to process.
- Allow the reconciliation to finish.
- Review the completion summary.
- Investigate skipped or failed records individually.
Auto Reconcile makes claim tracking more efficient, but it does not replace reviewing clearinghouse reports. The report remains an important source of information about claim acceptance, rejection, denial, payment, and other processing activity.
If you need help interpreting a report or determining why a record was skipped, use Ask Eddie or contact ElderSuite Support.
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Open Claim Center → View Reports, review the correct clearinghouse report, then use Auto Reconcile to apply eligible claim-status updates.
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