Billing Errors FAQ

Always make sure you follow the Horizon Recommended Billing Process.

Billing File is Rejected

ISSUE: I am trying to re-bill for a needs level change for one individual. The claims cover the last four months. I created and submitted the billing file with the correct amount/time frame. When I review the EDI Billing Verification (TXN), it shows all claims are rejected. 

  1. There is a limit on the number of claims that can be submitted in a PROMISe billing file.
  2. There can only be 100 claims for the same individual in one file.
  3. If your billing file included 101 claims for the same individual, all 101 claims will be rejected.
  4. To resolve, generate four monthly billing files instead of one file for four months of services.

Creating Residential Attendance

ISSUE: I'm trying to create residential attendance using TRANSACTIONS menu > Create Attendance.  I created attendance (both with/without day and ineligible services). I had to change the individuals service level so deleted the with/without day services to correct.  Now, when I try to create attendance, it will not create the corrected with/without day services.

  1. When you use the Create Attendance process, the system automatically creates both the with/without day service AND the ineligible services. 
  2. If there are ineligible services in the system for the same dates you are trying to re-enter, this process will not work.
  3. If you delete only the with/without day services but leave the ineligible services in the system, you need to re-enter with/without day services using the Service Entry screen.  The recurrence option can be used to quickly enter multiple days.
  4. If you delete both the with/without day services AND the ineligible services, you can use the Create Attendance process.

Date Error when Entering Services

ISSUE: I’m trying to enter services on the Transactions menu > Service entry screen. When I click save, an error appears "This date of service may be incorrect. Please enter the correct date."  The date is correct but I cannot save the service.

  1. The error appears because the system blocks you from entering services for a date that more than 30 days before the date of entry.
    1. For example, it is July 18 and you are trying to enter back billing for May 15. May 15 is 64 days.
  2. If you are certain the entry date is correct, click the OVERRIDE DATE icon BEFORE you click SAVE.

Invalid Accounting Period

ISSUE: I’m trying to post my cash receipts but am getting an error message for all of the transactions. The error is reading "Posting cannot proceed - An invalid deposit detected on receipt. A locked Accounting Period Detected on Receipt". How can I fix this?

  1. Follow these directions to setup a new accounting period. Setup Accounting Periods

Invalid Procedure Code

ISSUE #1: My agency just started providing a new service that we've never provided before.  I updated the facility master and all consumer service plans.  When I try to process billing, I get an error that says invalid procedure code.

ISSUE #2: I’m running the EDI Billing List for ERROR CHECKING and the report is saying the procedure code is invalid. How can I fix this?

  1. Typically, you will get the procedure code is invalid error when a new service code is setup.
  2. If you need to setup a new service code to start billing, follow these steps:  
    1. Setup Procedure Codes
    2. Setup Service Code Master
    3. In the Facility Master, on the fee for service tab, add the service code and the provider number in the last column.  See also: Setup New Facility
    4. Add the authorized service to the individual’s service plan.  Add a Service Plan
  3. When billing is processed, the system pulls the code and description from the PROCEDURE CODE list.  The procedure code list must match the codes as listed in HCSIS.  The service codes can be setup with your internal ‘friendly’ name that staff are familiar with/reference a particular service.  
    1. For example, W7060 needs to be listed as W7060 IHCS Level 2 (1:1) in the procedure code master.  The service code can be Community Support.

Not Enough Units

ISSUE: I am trying to bill for services provided but the unauthorized list says there’s not enough units, but there are enough units in the service plan.  

  1. Run the Service Detail Report for entire current service authorization time frame, i.e, 7/1/xx to 6/30/xx.
  2. Be sure in the OPTIONS, Select Data From to select Entry/History.This will show you the total number of units billed during the time frame. Compare the total number of units on this report to the number of units authorized.  Typically, the amount on the report is more than the authorized services - which is why they are appearing on the unauthorized report.  
  3. If the billing you are trying to process puts the overall number of units over the authorized amount, you will need to either remove some of the claims or adjust the number of units in the service plan to submit all. 
  4. For example, if you are trying to submit billing for eight units but only six units are left in the service plan, all eight units will not process.

Rebill Denied Services due to PROMISE Issue

ISSUE: I submitted billing to PROMISe and all services were denied.  After contacting PROMISe, it was an issue on their end.  They resolved the problem and now I need to resubmit the denied services. 

  1. If the issue was entirely on the PROMISe side and they corrected, you just need to resubmit the claims.
  2. Repeat your regular billing process starting with the Unauthorized Service Listing.
  3. When you run the EDI billing process, select the BILLING STATUS DENIED CLAIMS.
  4. The EDI file will only include the denied services in the time frame you entered.

Unauthorized Service Listing Showing Entries in Yellow

ISSUE: I'm trying to bill for services and the unauthorized service listing shows the entries highlighted in yellow. The individual was changing locations and we were waiting for HCSIS to be updated.  The individual has the service plan with correct dates.  I corrected the services to the current services after HCSIS was updated. Some services are highlighted and other are not.

  1. If you enter services BEFORE the service plan (authorization) is entered, the services will be highlighted in yellow.
  2. To correct, run the Unauthorized Listing for just the one person you are working with and the date range.
  3. Check the UPDATE SERVICE AUTHORIZATION NUMBER check box.
  4. This process will rebuild the services and find the current/correct authorization.

Unauthorized Report Shows All Services as Unauthorized

ISSUE: I'm running the unauthorized report and all services are showing as unauthorized?  The clients have service authorizations entered.  When I look at the service ticket detail, the consumer authorization number is not listed on the ticket.

  1. Review the consumer setup
    1. Make sure the consumer is open to the facility
    2. Make sure the consumer has Promise listed as their payor
    3. Make sure the service plans are correct
  2. Review the facility master setup
    1. Review the provider number - is the same number listed on the General tab and on each line of the Fee for Service tab
    2. On the AR groups tab, is Promise listed
    3. On the Fee for Service tab, is the Unit type correct
    4. Authorization Count by Dollars - typically this box is NOT checked.  It should only be checked when service auths are tracked by overall total dollars NOT units.  

Wrong Procedure Code Submitted/Denied

ISSUE: I submitted billing with the wrong procedure code and billing was denied.  I have everything corrected in the system and need to re-submit with the correct code.

  1. Make sure you correct the consumer service authorization setup in the Consumer Master
  2. In the Service Maintenance screen, roll back the denied claims.
  3. In the Service Maintenance screen, delete the denied claims.
  4. Recreate the correct services and complete your billing process.

7/2023

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