If you pay the carrier’s invoice as billed, you are trusting its enrollment records over your own.
Carrier invoices disagree with enrollment more often than anyone expects, and the difference rarely corrects itself. We reconcile the bill line by line against your eligibility records rather than forwarding it, and we chase every discrepancy to a credit or a correction.
Every billing error starts as a change that reached one system and not the other.
An invoice is only as current as the last enrollment file the carrier accepted. When HR, payroll and the carrier each hold a different version of the truth, the invoice follows the carrier’s.
Terminations That Never Landed
A departed employee who stays on the bill costs a full premium every month, and the longer it runs the harder the credit is to recover, because many carrier contracts limit how far back a retroactive termination will be honored. Try our free age-rated premium calculator to run the numbers for your own group.
Tier Changes
A marriage, a birth or a dependent aging off moves an employee between coverage tiers. If payroll deducts at the new tier and the carrier bills at the old one, the employer quietly absorbs the gap. Tier changes are a common source of carrier billing errors.
Rate and Age Band Errors
A renewal loads new rates, or an employee crosses an age band, and the invoice keeps the old figure. We check billed rates against the signed renewal, not against last month’s bill. Rate checks against the renewal catch billing errors.
Duplicate and Orphan Records
A rehire under a new ID or a name change can create a second record billing alongside the first. Only a line-by-line match against your census catches it, so that is what we do. Census matching catches duplicate billing records.
A dispute the carrier can act on is a list, not a complaint.
Carriers correct bills quickly when the request is specific: who, which coverage, which months, what amount and why. We build the request that way, so the answer is a credit rather than another round of questions.
Three-Way Match
We compare the invoice to your eligibility records and to payroll deductions. When all three agree the bill is right; when two agree, the third is the error, which tells us exactly where to send the fix. A three-way match is the core of premium reconciliation.
Retroactive Credits
The ACA’s rescission rules tightly limit retroactive cancellation, and whether a late termination qualifies turns on whether anyone kept paying premium for that person. We time credit requests so the fix does not create a coverage problem for someone mid-claim.
Follow Through to the Next Bill
A promised credit is not a credit until it appears on an invoice. We confirm it posted, and that the record behind it was corrected, because an error fixed on the bill but not in the system comes back next month.
Some billing questions are policy questions in disguise.
Reconciliation surfaces choices the employer has to make. We lay them out with the cost of each option, so the decision is deliberate rather than defaulted.
When Coverage Ends
End of the month or the day of termination is a plan design choice, and it should match the plan document, the handbook and the carrier. When they disagree, the bill will disagree too. Consistent coverage end dates prevent billing errors.
Payroll Deduction Gaps
When an employee on unpaid leave stops contributing, someone still owes the carrier. We help you set a recovery policy before the leave, not after the premium has been paid for months. A written leave premium recovery policy prevents disputes over who owes the carrier while an employee is out.
Continuation Coverage Billing
COBRA enrollees billed on the active invoice blur who has paid what. We keep continuation premiums separate, so an unpaid election never becomes the employer’s premium. Separate COBRA billing keeps premium responsibility clear and keeps the carrier invoice accurate. Each continuant gets a separate bill and a separate record.
What finance and HR ask about carrier invoices.
Should we short-pay a bill we think is wrong?
Rarely. Short payments can trigger delinquency notices that threaten the whole group’s coverage. We pay what is right, dispute the rest in writing and track the credit. Written disputes protect group coverage. Short payments can put coverage for the whole group at risk, so pay and dispute instead.
How far back can we recover overpayments?
It depends on the carrier contract and the reason for the error. We read the contract terms before promising a number, and we open the request as soon as the error is found. Prompt action protects overpayment recovery rights. Document every request.
Is this different on a self-funded plan?
Yes. The fixed fees bill per enrolled employee, and claims paid for an ineligible person are a separate problem. We reconcile both, since the second one costs more. Self-funded reconciliation covers fees and claims. Fixed fees and claims each need their own check against enrollment.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
COBRA Continuation Coverage (29 U.S.C. 1161)
Requires many group health plans to offer temporary continuation coverage after a qualifying event.
Affordable Care Act (Public Law 111-148)
The 2010 health reform law, with later amendments, behind employer coverage, reporting and market rules.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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