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

  1. Go to Client Center or Claim Center

  2. Click Manage Payment Types

  3. Click Add New

  4. 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

  5. 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.