How one small setup decision can prevent a mountain of billing issues later.
Introduction
You only set up a payment type once—but if it’s done incorrectly, you’ll feel the pain every single time a claim is generated, rejected, or manually corrected.
In ElderSuite, Payment Types determine how units are calculated, which procedure codes are used, what payer IDs are submitted, and how much you're reimbursed. In short, this one setup controls almost everything that happens in your billing process.
The good news? Get it right up front, and you’ll avoid countless billing headaches down the road.
What Are Payment Types?
A Payment Type is how you tell ElderSuite:
What kind of payer you’re billing (e.g., Medicaid, Private Pay, HMO/MCO)
How many hours count as one unit
What procedure and modifier codes to use
Which Payer ID should be included in the claim
What Place of Service Code applies
What the reimbursement rate is per unit, day, week, or month
You can manage these settings from either the Client Center or the Claim Center by clicking Manage Payment Types in the Related Activities panel.
Why It Matters
If your Payment Types are incomplete, inaccurate, or left with default values, here’s what can happen:
Claims generate with missing or incorrect codes
Units don’t calculate properly
Reimbursement is delayed or denied
Staff has to manually fix claims before submission
Claims are silently rejected by payers with no obvious error
And once you’ve submitted claims this way for weeks or months, the cleanup is slow, frustrating, and time-consuming.
Best Practices When Setting Up a Payment Type
When creating or editing a Payment Type, here’s what to focus on:
1. Use the Correct Payer Name
Use clear and specific names like “Molina Adult Day” or “TMHP Medicaid” so your team knows which payment type to assign.
2. Enter the Correct Clearinghouse Payer ID
This ID tells the clearinghouse where to route your claim. It must match what your clearinghouse expects. If you’re unsure, contact the payer or look it up in their online portal.
3. Assign the Right Procedure and Modifier Codes
These codes define the service you’re billing for (e.g., S5101 for Adult Day Care services). Again, check with the payer or your provider contract to confirm.
4. Define the Unit
If your payment type is per unit, don’t forget to define what 1 unit equals (e.g., 3 hours). This directly impacts billing automation.
Example:
“1 Unit = 3 Hours” means a client with 6 hours of attendance will generate 2 units.
5. Enter the Correct Reimbursement Rate
Set the correct dollar amount for each unit/day/month to match your provider agreement.
6. Leave Unused Types Inactive (Don’t Delete)
Deleting payment types removes historical data. Instead, mark unused ones as inactive so they can’t be accidentally selected in new records.
Quick Walkthrough: Adding a New Payment Type
Go to Client Center or Claim Center
Click Manage Payment Types
Click Add New
In the Payment Type Information window, enter:
Payment Type: Required
Clearing House Payer ID: Usually a 5-digit number
Place of Service Code: Usually "99" for Adult Day Health
Procedure Code and Modifier Code: As provided by the payer
Pay Rate: e.g., 15.00
Pay Rate Type: Unit, Day, Week, or Month
If Unit is selected: Enter number of hours that equal 1 Unit
Click Save & Close
Your setup is now complete and reusable across all client records.
Final Thoughts
A Payment Type setup may only take five minutes, but doing it right will save you hours of cleanup, dozens of support tickets, and thousands of dollars in lost reimbursements over time.
If you’re not sure whether your setup is correct—or you’re seeing inconsistent claim behavior—contact support. We’ll be glad to review it with you.