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 based on 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. 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.
  8. The report will tell you what is missing, i.e., diagnosis.
  9. Correct the issue and re-run the report before proceeding in the billing process.

Common Errors and Fixes

  1. Missing Consumer Information: Gender, Date of Birth, MA number, address
    → Go to the Consumer Master and enter the information
  2. Missing Diagnosis
    →  Fix this in the Program Status section of the Consumer Master.
  3. Missing Provider Number
    →  Go to the Facility Master, then the Fee for Service tab.
    →  Enter the Provider # in the correct column for the service code.

🔁 After Fixing Errors: Once errors are corrected, rerun the Unauthorized Services Listing and then this report to confirm all issues are resolved. 

2/2026

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