Invoice Reconciliation Process

Process FlowRequired Documents

The bill received from the carrier either via secure email or downloaded from the carrier's website
Invoice Reconciliation Report generated by Benefits Junction for the particular month of interest

Reconciliation Process

Compare the following against the carrier bill

The sum of the amounts under the ‘Total’ column in the Summary tab matches that on the bill
The count of enrollments in the Current Enrollments tab matches that on the bill
There are no records listed in the Membership Changes tab

Scenario #1: Everything matches

If the above statements are True, then the carrier has billed the enrollments accurately and there are no discrepancies for the current billing period.

Scenario #2: Counts don't match

If the count of enrollments in the Current Enrollments tab does not match that on carrier bill, review the list of employees on both documents to identify ‘missing’ records.

Note: The records are listed alphabetically on the Current Enrollments tab and are usually listed alphabetically on the carrier invoice as well.

Enrollments billed but are not on the Current Enrollments tab
- Employee is terminated from the company or has waived the coverage but not captured in the carrier invoice. This might occur if the termination of coverage is not sent through EDI or if the invoice is generated by the carrier before the information was received.
- If the missing record is on the Membership Changes tab, refer to the table below to identify whether the record must be on the bill or not.
- If the missing record is not on the Membership Changes tab, please research historical information updated on Benefits Junction or contact your Client Relationship Manager.
Enrollments are on the Current Enrollments tab but not billed
- Employee is enrolled in the Plan as per Benefits Junction, but the information is not captured in the Carrier invoice. This might occur if the Eligibility feed has not been sent through EDI or if the invoice is generated by the Carrier before the Eligibility was received.

Scenario #3: Totals don't match

If the premium under the ‘Total’ column in the Summary tab does not match that on the bill, check whether there has been a change in the admin fee or stop loss premium. If the employee is enrolled into the same plan and coverage as per Benefits Junction and Carrier but the premium amount does not match, this might occur if the premium rates are incorrectly updated on Carrier or Benefits Junction.

Understanding Certain Scenarios

Add/Term	Notes	Scenario
Start Coverage	Blank	Enrollments are considered 'new' because: This is the first bill generated on Benefits Junction This is the first bill generated for a new carrier This is the first bill generated after Open Enrollment New enrollment
End Coverage	Blank	Member has declined coverage Change in Eligibility resulted in termination of coverage
End Coverage, Start Coverage, and a third blank entry	Blank/Enrollment Changes need review	Member has changed plan and/or coverage Member has decline coverage Employment resulting in termination of coverage