Why One Payer Never Sends an 835 to ElderSuite

📝 Overview

An 835 remittance advice reaches ElderSuite only if the payer delivers it to the clearinghouse mailbox you download from. Not every payer does, and some do only after you enroll. If you download reports regularly and receive 835s from your other payers but never from one of them, that payer is almost certainly in one of the two situations below that need action from you.

ElderSuite serves adult day care centers nationwide. For what each downloaded report means, see The Billing Reports ElderSuite Downloads and What Each One Means. For opening the list, see How to View and Print Billing Reports in ElderSuite.

⚙ How It Works

1. Know the Three Situations

Every payer you bill through Availity falls into one of these:

1. The payer delivers 835s through Availity automatically. The remittance arrives with the next Download Reports run after the payer pays. Nothing to do.
2. The payer delivers 835s through Availity only after ERA enrollment. Until you enroll with that payer, no 835 is ever placed in your Availity mailbox, no matter how often you download. This is the usual reason one payer never sends an 835.
3. The payer does not deliver 835s through Availity at all. The remittance is available only on the payer’s own provider portal or on paper. It will never appear in the Billing Reports list, and you reconcile those claims by hand.

Texas Medicaid is separate. Its 835s come through the TMHP connection when you choose TMHP in the Select Clearing House prompt, not through Availity.

2. Tell Which Situation You Are In

ElderSuite cannot tell you, and neither can MicroSolutions, because ERA delivery is arranged between you, Availity, and the payer. Two places have the answer:

• Availity Essentials. Open My Providers, then Enrollments Center. It lists what each payer offers through Availity and whether enrollment is required or already complete. If Enrollments Center is not in your My Providers menu, ask your Availity administrator to grant it.
• The payer. Its provider services line or provider portal can tell you whether it sends ERAs through Availity, requires enrollment, or only posts remittances on its own portal.

Two things you can see in ElderSuite first:

• Other reports arrive for that payer, such as a 277CA or a delayed payer report, but never an 835. Your claims are reaching the payer. What is missing is ERA delivery, so you are in situation 2 or 3.
• No report of any kind arrives for that payer. That is a submission or routing problem, not an ERA problem.

3. Enroll for ERA Through Availity

ERA enrollment is done in Availity, not in ElderSuite. MicroSolutions cannot complete it for you or check its status.

1. Sign in to Availity Essentials.
2. Open My Providers, then Enrollments Center.
3. Choose the payer and the Electronic Remittance Advice (835) transaction.
4. Complete the payer’s enrollment form. It asks for your Tax ID and NPI. Availity uses the Tax ID to set up the mailbox your 835s are delivered to.
5. Wait for confirmation. Availity processes enrollments within three to five business days of receipt, and some payers take longer on their side.

Once the payer starts delivering, the 835s appear with your next Download Reports run. Enrollment does not go back in time. Remittances for claims the payer paid before enrollment took effect stay on the payer’s portal or on paper.

Some payers pair ERA enrollment with EFT enrollment for electronic payment and require both. The payer’s form will say.

Availity Client Services can help with the enrollment itself: 1-800-282-4548.

4. Reconcile by Hand When the Payer Never Sends 835s Through Availity

The remittance still exists, on the payer’s portal or as a paper EOB in the mail. Reconcile those claims by hand in ElderSuite:

1. Open Claim Center and click Reconcile Claims.
2. Find the date range and check the claims the remittance covers.
3. Click Change to..., pick the new status in Select New Claim Status, and click Change.
4. Click Save & Close. Nothing is saved until this click.

Auto Reconcile cannot be used for these claims, because there is no file to open. A paper EOB or a portal screen cannot be imported. See How to Reconcile Claims in ElderSuite and How Auto Reconcile Updates Claim Statuses in ElderSuite.

✅ Important Limitations

Downloading reports more often does not help. If the payer has not delivered an 835 to your mailbox, there is nothing to download.

Reports that arrived stay in the Billing Reports list. A report that was never delivered was never in ElderSuite.

A payer that has not finished paying may send nothing or a delayed payer report. A payer that paid but does not deliver ERAs through Availity shows the payment on its portal and nothing in ElderSuite.

There is no ElderSuite setting that turns on 835 delivery for a payer. Delivery is arranged between you, Availity, and the payer.

⚠ Enrollment Does Not Reach Back

ERA enrollment does not go back in time. Remittances for claims the payer paid before enrollment took effect stay on the payer’s portal or on paper. Reconcile those earlier payments by hand.

💡 Need More Help?

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