EDI Billing Edit List and Error Check

The report will show any claims that do not meet the required information to submit an electronic claim to PROMISe.  If everything is accurate, the report will be blank. The report will list any items that need corrected before the billing file is submitted.

For example, diagnosis is required in the PROMISe EDI billing file. If a claim is submitted without a diagnosis, the claim will be rejected. Run this report to make sure claims include all required information BEFORE the EDI billing file is submitted.

Horizon recommends running this report any time a new facility, service, or consumer is added to the system.

Report

NAVIGATION:  BILLING/AR menu > EDI Billing Edit List

  1. INSURANCE GROUP: select PROMISe
  2. PROGRAM: leave blank for all or select specific program
  3. SERVICE CODE: leave blank for all or select a specific code; typically when doing a re-bill
  4. FACILITY SELECTIONS:
    1. This grid will display a list of all the active facilities.  
    2. Facilities will be checked basedon your program selection.
    3. Place a check in the SELECT column to select the facilities you want to run the process for.
    4. Use the SELECT ALL or DESELECT ALL icons to check the facilities.  
  5. DATE SELECTION: enter or select the billing date range
  6. BILLING STATUS
    1. Leave blank during a regular billing
    2. DENIED CLAIMS: select this option if you are rebilling denied claims
    3. NOT BILLED: select this option if you are processing not billed claims from a previous time frame than the regular billing
  7. ERROR CHECK REQUIRED FIELDS: check box 
  8. Place a check mark in the NOTIFY box and click the PROCESS button.
    1. When the report is ready to review, a prompt will appear that says the report is complete. 
    2. Click YES to open the report in a new window.
    3. If you do not click notify, you will need to access the report from your dashboard and it will open in the same window.
  9. The report will tell you what is missing, i.e., diagnosis.
  10. Correct the issue and re-run the report before proceeding in the billing process.

Correcting Typical Issues

Any issue on the report is related to the consumer master record. Below outlines how to correct typical issues.

  1. Diagnosis
    1. Consumer Master > Program Status tab
    2. Click the link for the location to open the Status Form dialog box
    3. ID Diagnosis Primary: select the diagnosis; make sure the diagnosis name appears; click SAVE
  2. Date of Birth
    1. Consumer Master 
    2. Date of Birth: enter or select the date of birth; click SAVE
  3. Sex
    1. Consumer Master 
    2. Sex: use the drop down to select the sex; click SAVE
  4. Recipient Number
    1. Consumer Master 
    2. Recipient Number: type the person's recipient number; click SAVE
  5. Payor
    1. Consumer Master > Payor/Income tab
    2. Make sure the payor grid shows PROMISe with no end date
  6. Address
    1. Consumer Master 
    2. Enter the persons address including street, city, state, and zip code; click SAVE

8/2024

NEED MORE HELP?  Submit a ticket to the Help Desk or call (814) 535-7810 or (800) 889-3388