How to Edit a Claim on the Health Insurance Claim Form in ElderSuite

📝 Overview

The Health Insurance Claim Form shows one claim laid out like the printed CMS-1500. Item numbers on the screen match the printed form, so a payer note that cites an item points to the same place in ElderSuite.

Most of the claim is filled from the client, provider, and attendance records and is read-only here. A small set of claim-only fields can be typed or picked. Gold highlighting is the only signal that something is still missing.

ElderSuite serves adult day care centers nationwide.

Open the form from the Claim Center—from Scrub Claims, or from a row in Billing Report Viewer - Detail. This Guide covers editing a single claim on that window. It is not the pre-submission scrub, bulk status changes, Replacement or Void setup, or the full billing-report workflow. For those, see How to Scrub Claims in ElderSuite, How to Reconcile Claims in ElderSuite, How to Adjust a Submitted Claim in ElderSuite, and How to View and Print Billing Reports in ElderSuite.

⚙ How It Works

1. Open the Claim

There are two routes, and both start in the Claim Center.

From Scrub Claims, select a claim and double-click it, or click Edit Claim. If Scrub Claims has unsaved changes, ElderSuite asks: Changes have been made from Scrubbing Claims and must be saved or the changes will not be shown in the Claim Form. Would you like to save now? Choose Yes to save first, No to open without saving, or Cancel to leave the claim closed.

From View Reports, open Billing Reports, open a report so Billing Report Viewer - Detail appears, then double-click a row that has an Insured ID and a Service Date. ElderSuite looks up the attendance record for that insured I.D. and date and opens the claim. If no attendance record matches, the viewer shows The claim could not be found in the system. and the claim window does not open.

Only one claim window is open at a time. Opening another closes the one already on screen.

2. Clear Gold Fields and Edit Claim Values

When the window opens, and again each time you leave a field, ElderSuite re-checks the whole claim and turns gold every field that is still missing something. No message appears for a missing value—gold is the only signal. Gold never blocks a save.

Choosing the insurance plan name in item 11c copies that payment type’s payer defaults onto the claim—pay rate, place of service, CPT/HCPCS service code, and modifier. Changes on this window apply to this claim only. Values that every new claim should start with are maintained in Claim Setup on the client’s record.

Use the Claim Status dropdown (above the form, top right) to change status for this one claim—for example back to Pending. For several claims at once, use Reconcile Claims in the Claim Center.

For Replacement, Void, and Original Reference No. on item 22, see How to Adjust a Submitted Claim in ElderSuite.

3. Review History or Print

Claim History opens a read-only Claim Status History window with Date, Employee, and Note. Close it to return to the claim.

Print opens the filled form in Report Viewer under the print name HICF 1500. Save As is not available on that report. Item 22 is left blank on the printed form—the resubmission code and original reference number are not written there.

4. Click Save & Close

Click Save & Close on the menu bar. ElderSuite saves the claim, brings up to six other open windows up to date when they are open—Scrub Claims, Reconcile Claims, Attendance & Transportation Records, Meal Records, Client Information, and Clients—then closes the claim window. If you opened from Scrub Claims, that list returns to the same row, scroll position, and filters.

The window has no Cancel button. The title-bar X asks Would you like to save your changes? when something was edited. Yes saves the same way Save & Close does; No closes without keeping those edits.

✅ Important Limitations

This window edits one existing claim. It cannot create a claim and it cannot delete one. ElderSuite creates the claim when an attendance record is added on Attendance & Transportation Records, and removes it when that attendance record is removed. The claim must be Pending before that attendance record can be deleted or modified.

Most fields are read-only here because they come from the client, provider, or attendance record. Correct those sources when the tooltip points there—for example the patient’s name on Contact Information, the date of service on attendance, or the NPI in the Provider Center.

Gold highlighting never blocks a save. Scroll the form and clear gold before you close when the claim should be complete.

The Claim Status dropdown changes one claim only. Use Reconcile Claims for several.

A billing-report row without a matching attendance record shows The claim could not be found in the system. and does not open this window.

Item 22 is not printed on HICF 1500. Report Viewer does not offer Save As for that print.

⚠ Gold Does Not Block a Save

Gold is a checklist, not a lock. Save & Close works while fields are still gold. Whether anything is still missing is recorded with the claim so other windows can see it. Before you leave, scroll the whole form and clear every gold field when this claim should go out complete.

💡 Need More Help?

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