ElderSuite Claim Center Overview

📝 Overview

The Claim Center is the starting point for ElderSuite's claim workflow. From one screen you scrub claims, process them for submission, download clearing house reports, and reconcile what the payer paid or denied—and, on Texas facilities, create and reconcile ISS statements for program providers.

ElderSuite serves adult day care centers nationwide.

The Claim Center has no data-entry fields of its own and saves nothing. Every change to a claim, statement, payment type, claim status type, clearing house, or ISS program provider is made in the windows it opens. Each of those screens opens as its own window inside the ElderSuite main window (or, for Process Claims, as a dialog on top of the Claim Center). If a screen is already open, ElderSuite brings it to the front instead of opening a second copy.

⚙ How It Works

1. Open the Claim Center

Click Claim Center on the ElderSuite main menu. Users at the Full Access level always see the button. Everyone else needs the Claims Center permission on their employee record in the Provider Center. See How to Add Employees and Set Permissions in ElderSuite.

2. Work the Claim Workflow Buttons

The claim workflow buttons are meant to be used in order. The badges show the sequence while the Claim Center is selected; ElderSuite does not stop you from clicking a later step first, but Process Claims picks up only claims a saved scrub has marked error-free.

• Scrub Claims (step 1): reviews Pending claims for the period, fills available billing details, and flags unresolved errors. See How to Scrub Claims in ElderSuite. To open one claim from that list, see How to Edit a Claim on the Health Insurance Claim Form in ElderSuite.
• Process Claims (step 2): opens the Process Claims Wizard to build the electronic claim batch and upload it to the clearing house. See How to Process Claims in ElderSuite.
• View Reports (step 3): opens Billing Reports, where you download and read clearing house responses. From a report you can also run Auto Reconcile—see How Auto Reconcile Updates Claim Statuses in ElderSuite.
• Reconcile Claims (step 4): opens Reconcile Claims, where you post what the payer paid or denied. See How to Reconcile Claims in ElderSuite.

A client's own claim details—payment type, insured I.D., diagnosis, and service codes—are set in Claim Setup on that client's record, not on the Claim Center. See How to Use Claim Setup in ElderSuite.

3. Use the ISS Statement Buttons on Texas Facilities

On Texas facilities, a second row under the claim workflow carries two more buttons. On every other account that row is hidden.

• Create ISS Statements: opens the ISS Statement Wizard, which builds the statement a program provider receives—the hourly counterpart of processing claims. ISS days do not appear in Scrub Claims or Process Claims.
• Reconcile ISS Statements: opens Previous ISS Statements, where you work statements already sent to program providers.

There is no separate ISS permission. Create ISS Statements uses the Process Claims permission, and Reconcile ISS Statements uses the Reconcile permission.

4. Keep Supporting Lists Current in Related Activities

The Related Activities section opens the lists claims depend on:

• Manage Payment Types: the payers and payment types claims are billed against.
• Manage Claim Status Types: the claim statuses used when reconciling. See How to Manage Claim Status Types in ElderSuite.
• Manage Clearing Houses: the clearing house connections used for electronic submission.
• Manage ISS Program Providers: the program provider list ISS statements are issued to. This link appears only for Texas facilities.

5. Review the Stale Claims Banner

When claims at Submitted have an attendance date more than 30 days old and no more than 180 days old with no payer response yet, a banner appears across the top of the Claim Center. Click Download Reports to open Billing Reports, or What is this? for an explanation. See Claims Awaiting Payer Response in ElderSuite.

Only Process Claims moves a claim to Submitted, so private-pay and never-submitted records are never counted on the banner. Dismissing the banner hides it until ElderSuite is next started.

6. Check Permissions When Something Is Grayed Out

Permission checks on the Claim Center apply only to users at the Limited Access level. At any other access level, every button and link stays enabled.

For Limited Access users, each workflow button and Related Activities link needs its matching permission on the employee record: Scrub Claims, Process Claims, View Reports, Reconcile, Manage Claim Status Types, Manage Clearing Houses, and the Manage Payment Types permission (Claims Center). Create ISS Statements and Reconcile ISS Statements borrow Process Claims and Reconcile; Manage ISS Program Providers borrows Manage Payment Types (Claims Center). There is no separate ISS permission.

Ask an administrator to grant the permission in the Provider Center (How to Add Employees and Set Permissions in ElderSuite). It takes effect within five minutes on the next Claim Center you open, or right away after signing out and back in. A Claim Center that is already open keeps its buttons until you close and reopen it.

✅ Important Limitations

The Claim Center saves nothing and prints nothing. Printing happens in the windows it opens—Billing Reports, Reconcile Claims, and the ISS Statement Wizard.

Process Claims gathers only Pending claims that a saved scrub has marked error-free. A claim that has never been scrubbed, or whose scrub was closed without saving, is never billed from this workflow.

ISS days on Texas facilities are billed by statement to the program provider, not through Scrub Claims or Process Claims. Centers outside Texas do not see the ISS buttons or the Manage ISS Program Providers link.

For correcting a claim that was already submitted, see How to Adjust a Submitted Claim in ElderSuite.

💡 Need More Help?

For step-by-step assistance, click Ask Eddie from within ElderSuite.