Master Benefit Invoice Reconciliation

Required Permissions in Workday

[[Warning]]Before setting up the reports, ensure that the user configuring them has the necessary Domain Security Permissions. These permissions allow access to benefit elections, payroll results, and worker profile data, all of which are needed for complete and accurate reporting.[[/Warning]]

1. Person Data: Personal Data
2. Reports: Pay Calculation Results for Pay Group
3. Reports: Pay Calculation Results for Worker
4. Reports: Payroll Input
5. Worker Data: Beneficiary SSN Reporting
6. Worker Data: Benefit Elections
7. Worker Data: Benefits
8. Worker Data: Compensation
9. Worker Data: Current Job Profile Information
10. Worker Data: Dependents
11. Worker Data: Dependent SSN Reporting
12. Worker Data: Personal Notes
13. Worker Data: Workers

Creating the Enrollment Report for Reconciliation

The Enrollment Report captures a snapshot of each employee’s current benefit elections, along with employee and dependent personal information. It includes data such as plan type, coverage tier, effective dates, individual and employer costs, and dependent details. This report serves as the foundation for enrollment-based reconciliation—comparing who is covered and at what cost.

• Report name:  TCensus
• Report Type:   Advanced
• Data Source:   AllBenefit Elections

Columns

Group column heading

Filter settings

Prompt

[[Note]]Tip: Use clear column heading overrides to ensure consistent data mapping. Prompt filters like effective as of date and entry date help align records with the billing period of the invoice being reconciled.[[/Note]]

Creating the Payroll Report for Reconciliation

The Payroll Report is used when performing payroll-based reconciliation, where deductions are matched against invoice charges. This report includes details such as deduction codes, payment dates, coverage periods, and calculated values like employee contributions.

Custom calculated fields are needed to extract deduction descriptions or contribution amounts from Workday’s global payroll structures.

• Report name: TPayroll
• ‍Report Type: Advanced
• ‍Data Source: Payroll Results
• ‍Data Source Filter: Pay Calculation Results for Pay Group and Period

[[Note]] If you use multiple pay groups or pay frequencies, be sure to prompt for period start/end dates and validate that the data aligns with your billing cycle.[[/Note]]

Exporting the Reports for Reconciliation

Once both reports are configured and tested, they should be run monthly and saved in Excel format. Make sure the reports are shared with the appropriate user group or integration system account responsible for processing the data.

Depending on your Tabulera Benefits Reconciliation Module plan, there are two options for loading the reports:

• Starter Plan – Read this article to learn how to manually upload and map source data.
• Enterprise/PRO Plans – Go to the Tabulera platform, navigate to the Sources menu, and select the month you are uploading data for.

Summary

Reconciling benefits invoices using Workday data helps organizations:

• Confirm that employees are correctly enrolled in benefit plans
• Ensure that payroll deductions match invoice amounts
• Identify and resolve discrepancies before they result in billing errors

By combining structured Workday reports with Tabulera's Benefits Reconciliation Module, teams can build a repeatable monthly process that replaces manual audits and reduces the risk of errors.

When working in the Reconciliation Module, you can now regenerate invoices directly from the invoice view—no need to go back to the invoice list.
This small enhancement removes extra steps and helps you move faster.

How-to regenerate invoice

The refresh button is located in the top right corner of the Statistical Panel, right next to the Plan Configuration button.

Uploading Enrollment, Payroll and COBRA Remittance Data

The process for uploading Enrollment and Payroll data is identical. These files are typically generated from your Enrollment, HRIS, Payroll and COBRA vendors.

Before uploading, please download and use our file template to ensure the required fields are included.

→ Download Enrollment File Requirements

→ Download Payroll File Requirements

→ Download COBRA Remittance File Requirements

File Upload Process

1. Go to the Sources menu in the Tabulera platform.
2. Select the Source type (Payroll, Enrollment or COBRA).
3. Choose the period you are uploading the file for.
4. Click Upload File and locate the file on your device.

[[Note]]If this is your first upload, a modal window will appear prompting you to complete the file mapping. For subsequent uploads, click the Mapping button to open the mapping wizard.[[/Note]]

Mapping Your Data

Data mapping means telling the system which columns in your file match the fields Tabulera needs—like saying “this column is the employee name” or “this one is the plan type.”

The mapping process is identical for Payroll and Enrollment. Mapping is typically done once, unless the file format changes. Tabulera’s built-in AI assists in mapping most fields automatically.

Let’s quickly review the mapping wizards interface.

• The left panel displays both required and optional fields.
• Mandatory fields are marked with a red asterisk (*).
• [[Error]]Red highlights indicate a required field that hasn’t been mapped yet.[[/Error]]
• [[Warning]]Orange highlights indicate optional but recommended fields that are still unmapped.[[/Warning]]
• Click any unmapped field and select the corresponding column from your file.
• The right panel displays a preview of the values in that column. In some cases, you may need to help match these values to the format Tabulera expects.

Once all required columns and values are mapped, click **Submit Mapping**. You’ll be returned to the Sources menu and the file status will update to **Completed**.

Next Let’s switch to the Carrier Invoice Section.

Uploading Carrier Invoices

To upload a carrier invoice:

1. Go to the Carrier Invoices section.
2. Click Upload Files and select the invoice file.

[[Note]]The Starter Plan supports CSV and XLSX formats.[[/Note]]

If it’s your first time uploading a specific invoice format, you’ll need to complete the mapping process. Future uploads will not require remapping unless the format changes.

Click the Mapping button to launch the wizard.

Locating Member Tables

Tabulera’s built-in AI will attempt to auto-detect the tables containing member data. If the selection isn’t accurate, you can click Remove and manually select the correct table.

To Add and Remove a Table:

• Click once on the header row.
• Click again on the last row of the table.
• If the invoice includes multiple tabs, navigate them just like in Excel.
• You may select more than one table.

Mapping Invoice Columns

After selecting a table, you’ll see an orange section indicating that the columns aren’t yet mapped. Click Review Columns to launch the mapping wizard.

• [[Error]]Red highlights = required columns. [[/Error]]
• [[Warning]]Orange highlights = optional but useful. [[/Warning]]

Click the dropdown next to each field and select the corresponding column in your invoice.

Mapping Invoice Values

Next, check any lines marked with a red asterisk (*). These values must be reviewed and confirmed using the right-side panel. Assign any unmapped values as needed.

Next, check any lines marked with a red asterisk (*). These values must be reviewed and confirmed using the right-side panel. Assign any unmapped values as needed.

Once mapping is complete:

• The Column Mapping Status will turn green.
• Repeat the process for each table in the file.
• Click Submit Mapping when done.

You’ll return to the Sources menu and the invoice status will update to Completed. Repeat for any additional invoices you plan to reconcile.

That’s it! You’re now ready to move on to the Benefits Reconciliation application.

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Invoice List View

When you launch Reconciliation for the first time, you’ll land on the Invoice List View. From there, everything you need is available through a clean and intuitive layout. Let's walk through each part of the screen from top to bottom.

Top Navigation

Hamburger Menu (top-left): lets you switch between Payroll and Enrollment reconciliation views.

Reconciliation Period Selector: just below the menu, you’ll find the month selector. Click on it to pick the reconciliation period. Tabulera supports one month at a time, keeping things focused.

Statistical Panel

This panel gives you a quick summary of your current reconciliation progress. It shows:

• Beginning Variance – the total amount off at the start.
• Resolved Amount – how much you've already explained or written off.
• Over Collected – extra payroll deductions compared to what was invoiced.
• Under Collected – missing payroll deductions compared to the invoice.
• Discrepancy Count – the number of employees with variances, including how many are currently marked as In Progress.
• Plan Balance – how much has been collected and adjusted for the plan since inception. You can view the plan balance across all time, or narrow it down by selecting specific effective dates. Tabulera creates employee plan-level transaction registers, so you have a clear balance history down to the penny.

Invoice List

Here you’ll see all the uploaded invoices for the selected month, along with key statistics.

• The table is fully configurable: enable or disable columns by clicking the Columns button in the bottom-left corner.
• You can search within the Invoice Name and Plan Type columns by clicking the column header.
• To apply changes to invoice mapping or settings, use the Regenerate button next to the invoice name.
• You might also see different invoice statuses—these indicate if action is needed.
• Columns can be resized or sorted. Drag the dotted edge to resize or click the sort icon.

Employee List View

Click on any invoice to open the Employee List View. The layout is similar to what you’ve already seen, so it should feel familiar.

Statistical Panel

The panel at the top of this view changes depending on the reconciliation type you're working with.

Payroll Reconciliation

It’s almost the same as in the Invoice List View, but with one extra tile:

• Total Amounts – shows the total from the carrier invoice and payroll data side-by-side.

Enrollment Reconciliation

Switching to Enrollment Reconciliation updates the panel:

• Total Amounts – totals from both the carrier and the enrollment system.
• Plan/Tier Mismatch – employees with mismatched tier coverage.
• Rate Mismatch – employees with different rates.
• Carrier Bill Only – employees who are on the invoice but not in enrollment.
• Enrollment Only – employees in enrollment but not on the invoice.
• Discrepancy Count – number of employees with a variance.
• Plan Balance – running balance over time, filterable by effective date.

Employee Table

This table shows all employees listed on the invoice.

• Person, Carrier Plan, and Notes columns are searchable.
• A small person icon shows active/terminated status—click to filter.
• Use the Columns button to select which columns are visible.

Available Columns:

• Person
• Color Tag
• Client ID
• Plan Type
• Notes
• Enrollment Plan
• Payroll Plan
• Carrier Plan
• Carrier Premium
• Carrier Amount
• Payroll Amount
• Resolution Adjustment
• Resolution Reason
• Variance
• Plan Balance
• Reconciled Balance
• Reason
• Status

Utility Panel

The bottom panel contains tools designed to speed up your work.

• Columns: Show or hide fields in the Employee Table.
• Mass Update: Apply bulk updates to selected employees:
  • Add notes
  • Change statuses
  • Update color tags
• Mass Refresh: Re-run reconciliation after updates.
• Mass Adjustment Upload: Upload templates for Beginning Balance, Write-offs, or Adjustments.
• Reports: Generate and download reconciliation reports. More on this in the [Reports article].
• Three-Dot Button: Clear the app cache after backend updates.
• Configure Button: Access Plan Configuration and Member Mapping. Each has a dedicated article.

Employee Detail View

When you select any employee in the Employee List View, the Employee Detail View panel slides in from the right.

Top Section

• Employee & Employer Name – shown on the left.
• Color Picker – tag employees for easier identification.
• Resolution Button:
  • Shows Auto Resolved and is locked if no discrepancies are found.
  • If discrepancies exist, use Mark Resolved to update and sync stats.
  • Dropdown options:
    • Mark In Progress
    • Mark Resolved for Prior Periods

Notes Section

Add internal notes related to this employee. Use Mass Update in the Utility Panel to apply notes to multiple employees.

Middle Section

• Left: Demographics, hire and termination dates.
• Right: Resolution reason, who resolved it, and when.

Bottom Section

Five tabs give you deeper visibility:

1. Plan Balance – Detailed transaction register for each plan.
2. Detailed View – Shows plan-level info and paycheck data. Download via Payroll Paychecks button.
3. Member Mapping – Manage mappings at the member level. See the dedicated article for full instructions.
4. Plan Mapping – Edit plan-to-plan mappings. A full guide is available.
5. Activity Log – Tracks all user actions within the Benefits Reconciliation Module. See the Activity Reports article for more.

The Plan Balance tab acts as a running ledger of all financial transactions tied to the employee’s benefit plans. It gives you a detailed view of how premiums have been collected, adjusted, or written off over time. Two key tools in this view help you maintain accuracy: the Manual Adjustments button allows you to post Beginning Balances or apply Write-offs when needed. The Reconciled Balance toggle lets you switch between the actual balance and an adjusted view that accounts for payroll frequency differences, helping you align more accurately with carrier billing cycles.

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‍New Invoice Added

When you open the Benefits Reconciliation Platform for the first time or add a new invoice, a gear icon will appear next to unconfigured invoices. Click it to start the Plan Configuration wizard, which will guide you through setup.

1. Invoice Plans

Enable or disable any plans that don’t need reconciliation, like administrative fees and change plan type if needed.

2. Enrollment Plans

These come from HRIS and correspond to the selected invoice. If the system labels a plan as “Undefined” or is wrong, use the Edit button to update it. A filter option helps navigate large master plans.

3. Deduction Codes

These codes are pulled from payroll data and link payroll deductions to benefit plans. Enable or disable the deduction codes you wish to include in the reconciliation with a checkbox in the first column, change or assign plan types by clicking the edit button in the Plan Type column.

4. Add Margin Fee (optional)

In some cases, payroll or enrollment data may include margin fees or admin fees that need to be adjusted for accurate reconciliation. The system allows you to subtract these fees either as a percentage or as a flat dollar amount.

You can now apply margin fees to individual plan codes or in bulk, across multiple plan codes at once.

To add a margin fee to a single plan code:

• Click + Add Margin Fee
• Select Source: Enrollment or Payroll
• Choose the Plan Code and select the Target*
• Enter the margin amount (percentage or dollar value)

To add a margin fee to multiple plan codes:

• Click the Bulk Add Margin Fee icon next to the + Add Margin Fee button
• Select Source: Enrollment or Payroll
• Choose multiple Plan Codes that share the same margin fee and Target*
• Enter the margin amount (percentage or dollar value)

[[Note]]What is Target? The Target defines where the adjustment will be made—usually from the payroll data but in some cases, from the carrier invoice.[[/Note]]

Once configured, the system will automatically subtract the margin/admin fee from the payroll or enrollment amounts tied to the selected plan(s).

[[Note]] The Margin Fee step is optional and can be skipped if no adjustments are needed. [[/Note]]

5. Map plans

Plan Mapping links plans across invoices, enrollment data, and payroll deductions.

The interface consists of three columns:

• Invoice Plans (from the carrier invoice)
• Enrollment Plans (from HRIS)
• Deduction Codes (from payroll)

[[Note]] The system automaps plans where possible, and any unmatched plans require manual selection. Unlike previous versions, tiers are no longer displayed—only plan names, which makes the selection much easier and cleaner.[[/Note]]

How to Map Plans:

• Select any row. A panel will slide out from the right, displaying three tabs for different data sources.

• In the Enrollment or Deduction Codes tab, select all related plans (you can choose multiple options).

• In the Invoice Plans tab, you can merge multiple plans into a single row if necessary. Some plans, like Life Plans or Life AD&D, may be merged into a single row. If needed, you can unmerge them by clicking the Split button.

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Activity Log

All plan mapping actions are automatically recorded in the Activity Log, ensuring full visibility and traceability.

Editing an Existing Plan Configuration

If there is a change in the plan configuration, users should update the settings to ensure the platform continues to function properly.

Follow these steps:

1. Select the invoice that needs updating.
2. Click the Configure button at the bottom of the screen.
3. Choose Plan Configuration.

1.Invoice Plans

Enable or disable any plans that don’t need reconciliation, like administrative fees and change plan type if needed.

2. Enrollment Plans

These come from HRIS and correspond to the selected invoice. If the system labels a plan as “Undefined” or is wrong, use the Edit button to update it. A filter option helps navigate large master plans.

3. Deduction Codes

These codes are pulled from payroll data and link payroll deductions to benefit plans. Enable or disable the deduction codes you wish to include in the reconciliation with a checkbox in the first column, change or assign plan types by clicking the edit button in the Plan Type column.

4. Add Margin Fee (optional)

In some cases, payroll or enrollment data may include margin fees or admin fees that need to be adjusted for accurate reconciliation. The system allows you to subtract these fees either as a percentage or as a flat dollar amount.

You can now apply margin fees to individual plan codes or in bulk, across multiple plan codes at once.

To add a margin fee to a single plan code:

1. Click + Add Margin Fee
2. Select Source: Enrollment or Payroll
3. Choose the Plan Code and select the Target*
4. Enter the margin amount (percentage or dollar value)

To add a margin fee to multiple plan codes:

1. Click the Bulk Add Margin Fee icon next to the + Add Margin Fee button
2. Select Source: Enrollment or Payroll
3. Choose multiple Plan Codes that share the same margin fee and Target*
4. Enter the margin amount (percentage or dollar value)

* What is Target
The Target defines where the adjustment will be made—usually from the payroll data but in some cases, from the carrier invoice.

Once configured, the system will automatically subtract the margin/admin fee from the payroll or enrollment amounts tied to the selected plan(s).

[[Note]] The Margin Fee step is optional and can be skipped if no adjustments are needed.[[/Note]]

5. Plan Mapping

Plan Mapping links plans across invoices, enrollment data, and payroll deductions. The interface consists of three columns:

• Invoice Plans (from the carrier invoice)
• Enrollment Plans (from HRIS)
• Deduction Codes (from payroll)

[[Note]] The system automaps plans where possible, and any unmatched plans require manual selection. Unlike previous versions, tiers are no longer displayed—only plan names, which makes the selection much easier and cleaner.[[/Note]]

How to Map Plans:

• Select any row. A panel will slide out from the right, displaying three tabs for different data sources.

• In the Enrollment or Deduction Codes tab, select all related plans (you can choose multiple options).

• In the Invoice Plans tab, you can merge multiple plans into a single row if necessary. Some plans, like Life Plans or Life AD&D, may be merged into a single row. If needed, you can unmerge them by clicking the Split button.

[[Note]] Once changes are made, go back to the invoice list and click Regenerate next to the updated invoice to ensure all updates are applied properly.[[/Note]]

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Inline Mapping

If employees still have missing amounts after completing the plan configuration, you can map them directly in the reconciliation view.

• Locate a plan type with a Carrier Plan name and click it

• A panel will slide out from the right. Navigate to More -> Plan Mapping -> Edit Mapping.

• Enable the missing plans. Ensure the amounts in the three column headers are equal.

• Click Save Changes.
• Employees with updated mappings will be highlighted in yellow, indicating that the Reconciliation View needs to be regenerated.

• To finalize, go to the Invoice List and click Regenerate next to the updated invoice.

New Plan Added

When working in the Benefits Reconciliation Platform, you may notice a yellow triangle next to an invoice name. This indicates that new plans have been added to the invoice and require configuration.

Simply select the invoice, and a notification will appear informing you that new plans were found. Click the Plan Configuration link to proceed. If you accidentally close the notification, don’t worry—you can always click the Configure button at the bottom of the screen and select Plan Configuration from there.

Inside the Plan Configuration wizard, you will see a list of new plans along with their plan types. You also have the option to turn off a plan if you do not wish to reconcile it. Once reviewed, continue with your standard plan configuration process.

How to Access the Mass Update Feature

1. Navigate to the Benefits Reconciliation application.
2. Select any invoice.
3. In the Employee View, at the bottom and click the Mass Update button.

What Employees Can You Mass Update?

Once inside the Mass Update tool, you can select and modify employees with the following statuses:

• Unresolved
• Manually Resolved
• In Progress

Select employees individually or use the checkbox in the column header to select all employees on the current page. If there are multiple pages, repeat the selection process for each page. The green “Update” button will display the total number of selected employees. Once your selection is complete, click Update to proceed.

Available Mass Updates

• Notes
• Resolution Status
• Color Change

Mass Updating Notes

• Check the box next to Update Notes.
• If the text field is left blank, existing notes will remain unchanged, preventing accidental overrides.
• Enter the desired text and click Update—the new notes will be applied to all selected employees.

Mass Updating Resolution Status

• Select the necessary employees.
• Choose the new Resolution Status from the dropdown.
• Click Update to apply changes.

Mass Changing Colors

• Check the box next to Color Change.
• By default, the selected color is white. If applied, this will remove any existing color from the selected employees.
• Choose a different color to apply a new highlight.

Try it today in the Benefits Reconciliation Module!

Setup your carrier credentials

• Access the Admin Section
• Select Carrier Credentials in the left navigation menu.
• Click the + Add Credential button.
• Give it a Unique Name: Create a name that helps you easily identify the carrier.
• Set Visibility: If multiple users need access to these credentials, select Company-Wide visibility.
• Select Invoices: Use the drop-down to select the invoices that these credentials apply to.
• Enter URL and Login Info: Type in the URL of the carrier’s login page along with your username and password.
• Create the Secret: Click Create to finalize.

Once completed, your credentials are securely stored using Delinea’s encrypted vault, ready for seamless access.

How to Use the New Feature

• Navigate to the Sources panel and select Carrier Invoices.
• Look for the globe icon next to the invoices linked to your credentials.
• Choose Your Access Method

Option 1: Use the Chrome Extension

• Click the globe icon next to the invoice.
• You’ll be redirected to the Chrome Web Store.
• Click Add to Chrome to install the extension.
• Refresh the Tabulera Portal to activate the extension.
• From now on, clicking the globe icon will automatically open the carrier’s login page with credentials pre-filled.

Option 2: Manual Copy/Paste

• Click the globe icon next to the invoice.
• A pop-up will display the link to the carrier’s login page and your stored login credentials.
• Copy and paste the credentials manually to log in.

With this new feature, you’ll save time, reduce login friction, and ensure your credentials are always secure. Whether you prefer the speed of an automatic Chrome extension or the simplicity of copy-paste, this update gives you the flexibility to access carrier invoices faster and more efficiently than ever before.

Count of "In Progress" Items

We’ve introduced a count of items marked as "In Progress" to the chart. Now, whenever you mark an issue as "In Progress," the total number of these items will display alongside the count of resolved records at the top of the page, giving you a quick overview of your progress.

Note Column Search Functionality

You can now filter the Notes column by typing keywords directly into the search box. Currently, this functionality works only for notes you’ve added manually, not system-generated ones. Enhancements are already underway, and this feature will be upgraded in Q1 2025.

How to Use It:

1. Open the invoice you need.
2. Scroll down and click Columns.
3. Add the Notes column.
4. Once the column appears, type your keywords into the Search box.

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Multi-Month Invoice Refresh

We’ve added the ability to refresh invoices across multiple months, streamlining your process.

How to Use It:

1. Go to the main screen where all invoices are listed.
2. Click on the Mass Actions button at the bottom of the screen.
3. Select Mass Refresh, choose the invoices you need, and locate the small calendar icon next to the Generate button at the bottom right.
4. Click the calendar icon to select your desired period, click Apply, and then hit Generate.

Color-Coding Employee Line Items

You can now color-code employee line items for easier visual identification.

How to Use It:

1. Select an employee.
2. In the slide-out Employee Details view, locate the Header section.
3. Click the circle icon and choose a color to assign.

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Introduction

In today's dynamic benefits landscape, brokers are continually seeking ways to enhance their service offerings and generate new revenue streams. One area gaining significant traction is premium administration services. As employers grapple with the complexities of benefits billing, invoice audits, and carrier payments, brokers have a unique opportunity to step in and provide valuable solutions. However, offering these services comes with its own set of challenges, especially when service teams are stretched thin.

The Competitive Landscape and Evolving Role of Benefit Brokers

Benefit brokers have traditionally served as intermediaries between employers and insurance carriers, helping businesses select the best benefits packages for their employees. However, the role is expanding. For instance, Professional Employer Organizations (PEOs), Association Health Plans and other group benefit arrangements offer a myriad of overlapping services including purchasing, reconciliation and payment of plan premiums. 

Small to mid-sized employers now look to service providers not just for plan selection but also for assistance with administrative tasks that accompany those plans. This shift presents both an opportunity and a challenge: brokers can increase their revenue by offering additional services, but they must also manage the operational demands these services entail.

Understanding Premium Administration Services

What Is Premium Administration?

Premium administration involves managing the processes related to benefits billing, including auditing invoices and ensuring accurate carrier payments. By handling these complex tasks, it relieves the employer's HR and benefits teams of administrative burdens that sometimes have more to do with accounting rather than benefits.

For employers, streamlined premium administration means fewer errors, reduced overpayments, and compliance assurance. For brokers, it opens up a new revenue stream and strengthens client relationships by providing a comprehensive service package.

Two Ways Brokers Can Assist with Premium Administration

There are two ways brokers can help clients with their premium administration needs and generate revenue.

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Option 1: Providing invoice audit as a service

Brokers already have access to their clients' enrollment data through systems like Employee Navigator or other HR software. This means they can offer benefits reconciliation services by using this data to audit invoices effectively. By comparing the enrollment information with carrier invoices, brokers can spot discrepancies including incorrect charges or coverage errors, which can happen as a result of human error or system misconfiguration on both, employer and insurance carrier sides.

Challenges of Manual Invoice Auditing

Manual invoice auditing, though seemingly straightforward, is labor-intensive and requires meticulous attention to detail. Brokers often lack staff with both accounting and benefits expertise, making the process inefficient and prone to errors.

These challenges become even more significant when working with clients who have complex company structures, multiple HR systems, and multiple locations. Sometimes, clients grow through mergers and acquisitions, bringing in subsidiaries that use different HR systems than the parent company. This adds layers of complexity to the auditing process. Brokers can assist these clients by figuring out exactly how much each location or business unit owes for their benefit plans. By bringing together and matching data from different systems, brokers help organizations handle this added complexity, ensuring billing is accurate and costs are correctly allocated throughout the entire company. However, doing this manually increases the risk of mistakes and can overwhelm service teams.

Case Study: Uncovering Invoice Discrepancies

A broker auditing invoices for multiple clients with 5,000 employees (avg.) on benefits and 128 invoices revealed significant discrepancies:

• 84% of plan participants automatically matched between the carrier invoices and the enrollment data.

Of the remaining 16% the following was observed: 

• 2% had a Tier Mismatch, where coverage levels differed (e.g., "Employee Only" vs. "Employee + Spouse").
• 17.5% showed a Rate Mismatch, indicating discrepancies between invoiced amounts and expected amounts.
• 33.5% involved Timing Differences due to Suspected Termination, where terminated employees were still on invoices.
• 35.5% had Timing Differences due to Suspected New Hires, with new employees not yet appearing on invoices.

While some discrepancies would resolve in subsequent billing cycles, issues like tier and rate mismatches could lead to financial losses or legal complications if left unaddressed. Auditing all employees and invoices manually each month is not sustainable, highlighting the need for streamlined processes.

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Option 2: Winning Large Deals with Limited Resources

Securing large contracts often involves responding to Requests for Proposals (RFPs), where employers outline their specific needs and expectations. These proposals require brokers to meet complex requirements and offer supporting service packages, which often include premium administration services.

For brokers, especially smaller ones or those without extensive administrative teams, meeting these demands can be challenging. Without the necessary infrastructure, competing for large deals can strain existing resources and make it tough to match larger firms with more substantial teams and systems.

An effective strategy is for brokers to partner with technology providers to bundle insurance offerings with software solutions. This approach allows brokers to provide tools that enable their service teams to handle benefit plan billing more efficiently. As a result, the agency can assist employer's HR and benefits teams to manage complex billing tasks across multiple locations or different HR systems, especially after mergers and acquisitions. Bundling these services gives employers a single solution to simplify benefit plan billing operations and improve efficiency, while brokers add value without overextending their resources.

The Importance of Invoice Auditing

Common Discrepancies and Their Impacts

Invoice discrepancies are not just administrative nuisances; they have real financial and legal implications. Overpaying premiums affects an employer's bottom line, while underpayments or coverage gaps can lead to compliance issues and employee dissatisfaction.

Financial and Legal Risks

Failing to identify and correct invoice errors can result in:

• Financial Losses: Paying for coverage not received or for terminated employees.
• Compliance Issues: Non-adherence to regulations like COBRA can lead to penalties.
• Employee Relations Problems: Employees may face coverage gaps, leading to mistrust and potential legal action.

Conclusion

Premium administration services represent a significant opportunity for benefit plan brokers and agencies to expand their offerings and strengthen client relationships. Whether by providing these services directly or by enabling clients through technology solutions, enable brokers to compete in the market and navigate the challenges of efficiency and resource management. Embracing technological tools and partnerships can help brokers deliver these services in a repeatable and high-quality offering without overburdening their teams.

How Tabulera Fits In

Tabulera offers a platform that seamlessly integrates with enrollment systems like Employee Navigator, isolved and other HRIS platforms enabling brokers to efficiently audit client invoices. With smart algorithms and configurable settings, Tabulera's benefits reconciliation module automates much of the auditing process. It filters out employees without discrepancies, highlights timing, rate, or tier differences, and aggregates benefits-related data in one place for easier research of the underlying issue. This allows brokers to focus on resolving genuine issues, significantly reducing the administrative burden. By partnering with Tabulera, brokers can enhance their service offerings, win larger deals, and provide clients with the tools they need for effective premium administration.

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How does it work?

‍Simply start typing the company name, employee, or dependent in the search box at the top right corner of the screen, then select the correct option from the suggestion dropdown.

Company Search

Type the company name in the search box and select it from the dropdown. You’ll be taken to a Company Summary Dashboard that shows:

• A list of carriers the company is enrolled with.
• Payroll deduction amounts with check dates.
• A list of employees working for that company.
• And if you’re using the EDI Carrier Connectivity Module, you’ll also see any sent EDI 834 and other EDI format files.

Enrollment History

The Enrollment Tab shows the history of enrollment files. You can see the upload dates, whether from direct system integrations or manual file uploads. By clicking on an enrollment file, you can view the members listed in that specific file.

Payroll History

The Payroll Tab displays the history of paychecks. Click on any payroll record to see the members associated with that paycheck, including deductions and contributions.

Employee Search

If you need to find information on a specific member (employee or dependent), simply type their name in the search box. The system will show the member’s details, including:

• The plans they are enrolled in.
• Dependent information.
• Paycheck details.

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What is Member Mapping?

When you’re performing a reconciliation and viewing the member list, you might notice some members with a red icon next to their names. This icon indicates that the member appears on an invoice but isn’t matched in Tabulera's database. This usually happens because the members name is different on the invoice compared to the Enrollment or Payroll systems, making it impossible for the platform to automatically connect them. The Member Mapping feature allows you to manually link these records.

How to Use Member Mapping

1. Filter Unmapped Members: Start by filtering the Member View to display only the unmapped members. Click on the icon in the Person Column and select “Not Enrolled Members.”
2. Select and Map: Choose a member from the list. In the panel that slides out from the right, navigate to the Member Mapping Tab. If you know the name as it appears in the HRIS, begin typing it, and select the correct entry from the suggestions. In our demonstration case, the invoice shows “Cat Grant,” and the HRIS lists “Catty Grant-Olsen,” you can map these records together. If you’re unsure of the exact name, start typing, and the platform will narrow down the options. Alternatively, you can manually enter the details if you know the members SSN. There’s also an option to ignore the mapping, which is useful for COBRA employees.

Advanced Options

In more complex scenarios, you can use the Advanced Options:

• “Activate this mapping only for the specified date range”: Use this when a member has changed companies, and you need the platform to recognize that the employee works for a different company after a certain date.
• “Apply Mapping to this Member Plan Only”: This option is for when you want to map a member for a specific invoice (e.g., for this month or year only).

Once you’ve mapped the member, click “Create Mapping.” The icon next to the employee’s name will change to a clock, indicating the mapping is complete. Remember, after mapping, you need to regenerate the reconciliation report. To save time, map as many employees as possible before regenerating.

Regenerate Reconciliation Reports

To regenerate the reconciliation reports, click on the Payroll/Enrollment Reconciliation Button in the Top Navigation menu. Then, click the Regenerate Button next to the invoice you’ve been working on.

Review and Adjust Member Mappings

To view all Member Mapping configurations for a specific invoice, go inside the invoice. At the bottom of the screen, click the “Configure” button and select “Member Mapping.” Here, you’ll see all your mapped members. If you need to correct any mappings, simply click the “Remove” button and remap the employee. Remember to regenerate the reconciliation report after making any changes.

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Activity Log: A Complete Record of Every Action

We’ve introduced the Activity Log—a feature designed to track every action performed within the Benefits Reconciliation Module. This running register provides an activity log at every level.

1. General Activity Report:

Accessed through the Invoice List View under the Reports Menu, this report offers an overview of activities across the entire Benefits Reconciliation application.

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2.Invoice-Level Activity Report:

This report is found in the bottom Reports section after selecting an invoice. It lists all activities associated with the selected invoice, giving you a clear view of each step taken.

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3.Employee-Level Activity Report:‍

Track activity associated to a specific employee. Access it by selecting an employee in the Employee List view, then clicking on the Audit Log tab in the Employee Details Panel.

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Enhanced Employee Detailed View: Now with Paycheck Data

We’ve updated the Employee Detailed View Panel to provide more insight. In addition to information from Carrier Invoices and Enrollment data, the panel now displays individual paycheck dates and associated deduction amounts.

Introducing the Source Report

The new Source Report feature, accessible at the bottom of the Invoice View through the Reports Menu, allows you to download source data as seen by our Benefits Reconciliation Platform. Choose from:

• All Data
• Enrollment Data
• Payroll Data
• Carrier Bills
• Company Employees

Payroll Frequency Adjustment

Companies using bi-weekly or weekly payroll deductions for benefit plan premiums require a different methodology to reconcile insurance carrier invoices. This methodology adjusts for the discrepancies that arise due to differing deduction cycles compared to the carrier invoicing cycle.

For example:

Bi-weekly payrolls have 26 deductions per year, resulting in some months having 2 and others having 3 payroll deductions. Consequently, all months will show a variance to the monthly carrier invoice. We adjust for this variance by creating a pay frequency adjustment, allowing users to see this adjustment as expected and marking it as 🟢Auto Resolved.

We have created a Reconciled Balance View that appears on the Employee Detail Panel, with all adjustments, including:

• Rounding
• Payroll Frequency
• Write-offs
• Beginning Balance

This Reconciled Balance View documents in a running ledger format how the invoice was reconciled each month.

The Reconciled Balance toggle disables the Payroll Frequency Adjustments to show the employee’s actual Plan Balance. For instance, an employee who starts deductions in a 3 payroll frequency month and terminates in the same month will show a refund owed to the employee under the Plan Balance View, but under the Reconciled Balance View, they will show a 0 balance due to a Payroll Frequency Adjustment being added to account for the expected variance.

Monthly Reconciliation Report Update

The additional Summary Reconciliation tab was added to the Monthly Reconciliation Report at the request of many of our client accounting teams. We’ve created an Excel Pivot Table to show a summary of all Adjustments and Plan Balances between the Payroll/Enrollment systems and the carrier invoices to tie these amounts to each other.

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“Column C” starts with the payroll system and “Columns D - H” show Adjustment Amounts.  “Column I” shows the balances created in the Employee Plan Balance View.

If you add the Payroll/Enrollment system totals in “Column C” and add the totals from “Columns D - H” and subtract the plan balances in “Column I”, this will equal the carrier invoice amount in “Column J”.

As you make adjustments, such as writing-off amounts, this report will change to reflect these adjustments. 

Why Are Benefit Invoice Audits Important for Brokers and Their Clients?

Employers audit their employee benefit invoices to catch errors and correct discrepancies, ensuring proper financial controls and making sure employees receive the health coverage they selected. In benefits administration, errors and discrepancies often arise from human mistakes on both the carrier and employer sides. Common issues include:

• System Misconfiguration: Incorrect rates being applied, wrong eligibility dates etc.
• Terminated Employees on Invoices: Employees who have left the company but are still being billed cause unnecessary expenses.
• New Hires Not Appearing on Invoices: New hires missing from invoices can lead to compliance issues.

Implementing benefit invoice audit processes helps identify and correct issues promptly, maintaining financial accuracy and efficiency. Brokers can assist their clients by leveraging tools and expertise to streamline this audit process, ensuring accurate billing.

Two Ways Brokers Can Help Their Clients with Benefit Audits Using Tabulera:

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1. Benefit Invoice Audits As A Service.

Brokers can leverage Tabulera’s Benefits Reconciliation Module by integrating it directly with any HR and Benefit Enrollment platforms. This integration allows brokers to upload clients’ carrier invoices into Tabulera, which then automates the discrepancy identification process.

According to our research, the efficiency of automated matching is around 84% with Version 3.0 of the Benefits Reconciliation Module; meaning brokers need to manually review only 16% of the total benefits-eligible employee population. Of these, statistically 10% are new hires and terminations in transit, which should auto-resolve next month, while 6% will have actual rate discrepancies, system misconfigurations, or plan mismatches that can cause financial leakage for the employer.

1. Automation: The system automatically matches invoices with enrollment data, significantly reducing manual effort. It efficiently identifies enrollments in transit (such as employees hired after the invoice generation date) and terminations in transit (employees terminated after the invoice generation date), as well as plan mismatches. The system highlights all discrepancies in order to address system misconfigurations or data errors.
2. Efficiency: Brokers can reconcile all of their clients' invoices or select specific clients that need this service within a single platform, streamlining their operations and enhancing service delivery.

2. Referrals for Enterprise Accounts.

Some brokers, particularly smaller ones, manage large, complex accounts that require detailed payroll reconciliations. For these accounts, brokers can become a referral source, directing clients to Tabulera’s solutions. This approach is especially beneficial for brokers who lack the capacity to provide detailed reconciliations effectively. By offering Tabulera’s software, brokers can equip their clients' HR teams with the necessary tools to perform benefits reconciliation accurately on their own, retaining their large clients and demonstrating creativity in finding solutions to their problems.
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1. Cost Savings: The reduction in billing errors and write-offs leads to significant cost savings for employers.
2. Financial Control: Controllers and CFOs will appreciate the improved financial oversight, knowing that their benefit plans are frequently reconciled.

Benefits of Using Tabulera’s Software

Tabulera’s Benefits Reconciliation Module is highly effective for accurately and efficiently auditing list-bill or self-bill invoices against enrollment or payroll data. The platform focuses on verifying that charges from insurance carriers or self-bill calculations align with actual enrollments and payroll deductions.

Key benefits include:

• Monthly Premium Reconciliation: Ensures that the premiums billed by carriers accurately reflect the enrolled employees and their selected plans, reducing overpayments and billing errors.
• Reporting: Provides detailed reports that highlight discrepancies, allowing brokers to address issues with carriers promptly and ensure accurate billing.
• Enhanced Efficiency: Tabulera’s software automates the tedious task of matching carrier premium invoices with payroll and enrollment data. This automation not only reduces the chances of manual errors but also ensures that discrepancies are identified and addressed promptly.
• ROI: Our clients have experienced significant financial benefits from using Tabulera’s software. For example, one case study revealed that a client eliminated 97% of benefit write-offs, showcasing the substantial ROI and improved financial accuracy achieved through our platform.
• Seamless Integration: Tabulera’s Benefits Reconciliation Module accepts enrollment and payroll data via API, reports, and SFTP connections from the most popular HR and Benefits platforms such as Employee Navigator, Workday, UKG Kronos, and ADP. It can also accept any enrollment or payroll report in Excel or CSV format. This compatibility ensures that brokers can easily incorporate our solution into their clients' existing systems without disruption.

Conclusion

By utilizing Tabulera’s Benefits Reconciliation Module, brokers can offer enhanced services to their clients, ensuring accurate and efficient benefit invoice audits. Whether integrating our module into their own systems or referring larger clients to us, brokers can trust Tabulera to deliver reliable, automated solutions that drive productivity and financial accuracy. Our proven technology not only simplifies the reconciliation process but also provides significant ROI, making it an essential tool for modern benefits administration.

Tabulera’s Benefits Reconciliation Module

Tabulera’s Benefits Reconciliation Module provides an automated, streamlined process to ensure accuracy in billing and reduce administrative burden. It matches carrier invoices against employee payroll, enrollment, and COBRA data automatically, identifying discrepancies in seconds. Key benefits include:

• The system automatically matches 84% of items, reducing the client's reconciliation workload to just 16%.
  
• Proven ROI in Q1
  
• The ability to eliminate 97% of write-offs within six quarters
  
• Track Plan Balances: Creates employee plan-level transaction registers for clear balance history, allowing for proper collection or adjustments of premium variances.
  
• User-Friendly Interface: Simplifies the reconciliation process with easy-to-use matching algorithms and a short learning curve. Sorts discrepancies by discrepancy reason and allows users to quickly focus on discrepancies that can cause serious potential financial losses.

‍Direct Integrations

Tabulera offers dedicated integrations with popular software platforms to enhance the benefits reconciliation process:

• iSolved and PrismHR: Enables automatic enrollment and payroll data stream, eliminating manual monthly enrollment and payroll generations.

• Employee Navigator: Facilitates seamless data exchange, ensuring accurate reconciliation of employee benefits enrollment data with carrier invoices. This integration is particularly useful for brokers expanding their offerings to clients.

In addition to these direct integrations, Tabulera is platform-agnostic and accepts files from any enrollment or payroll system, including UKG Kronosenrollment and payroll reports.

Why Make the Switch to Tabulera?

Try before you buy: Take advantage of Tabulera's free 90-day trial for clients switching from EverythingBenefits. This trial provides ample time to experience the platform's benefits firsthand and ensures a smooth transition.

Short implementation time: Tabulera offers a streamlined implementation process, minimizing downtime and ensuring rapid deployment.

Flexible configuration: Tabulera accommodates various payroll frequencies and supports both list and self-bill invoices. Additionally, it is capable of accounting for plan margins, providing flexibility to meet diverse client needs.

Track Plan Balances: Tabulera maintains clear balance history for accurate premium collection or adjustments, ensuring financial integrity and compliance.

Various Plan Structures: Tabulera works seamlessly with both self-funded and fully insured plans, offering flexibility to accommodate various plan structures

Organizational Structures: Tabulera seamlessly adapts to any organizational structure, including subsidiary companies, and facilitates the rebilling process accordingly.

Discrepancy Reason Classification: Tabulera automatically classifies discrepancy reasons, streamlining the resolution process and saving valuable time.

User-friendly interface: Tabulera's intuitive platform features a short learning curve, meaning you don't need to be an accountant to successfully reconcile benefits.

Continuous improvement: Unlike competitors, Tabulera is committed to constant improvement and development. With monthly new feature releases, you can trust that Tabulera remains at the forefront of innovation in benefits reconciliation.

Switching to Tabulera’s Benefits Reconciliation Module ensures PEOs can continue to manage their benefits billing accurately and efficiently, maintaining the high service standards their clients expect.

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‍Mass Actions - Generate Reconciliation Reports:

‍‍This feature empowers you to regenerate multiple or all reconciliation reports for a selected period of time with ease. No longer will you need to manually refresh each invoice after adjusting mapping configurations or uploading new invoices. To utilize this feature, simply navigate to the “Mass Actions” button located in the bottom left corner of the invoice list. From there, choose “Generate Report” and select individual invoices or use the checkbox in the table header to select all invoices. Click the “Generate” button and allow the reports to regenerate seamlessly.

Mass Actions: Beginning Balance

This feature allows for the mass entry of adjustments into the Plan Balance ledger, specifically supporting retroactive adjustments (Beginning Balance) for balances prior to the conversion to Tabulera.

To utilize this feature, simply navigate to the “Mass Actions” button located in the bottom left corner of the invoice list. Hover over "Beginning Balance" and select a "Generate Report" template. Then, either select individual invoices or use the checkbox in the table header to generate a template for all invoices. The template file will be downloaded as soon as it's generated.

Next, open the table with Excel and enter the beginning balances from the system you're migrating from in the last column. Ensure not to change any other values except for the last column. Once you've finished entering the amounts, return to the system, click on the "Mass Actions" button in the bottom left corner, select "Beginning Balance," and upload the report. The invoice will automatically regenerate.

If you've made a mistake and would like to remove all the beginning balance amounts, download the template and enter "0" in the last column, then reupload it. This action will revert your previous edits. If the invoice regenerates longer than expected, please refresh the page.

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‍Employee Status Filter:

‍This feature provides you with the ability to quickly display employees falling into specific categories, including:

• Active Employees
• Terminated Employees
• COBRA Employees
• Employees not registered on the platform (commonly due to missing or incomplete SSNs). To address issues with these employees, please contact our support team at client.support@tabulera.com.

To access this feature, simply click the person icon in the header of the first column in the Employee List View. Then, select the desired employee status you wish to view.

We believe these enhancements will greatly improve your experience with our Benefits Reconciliation Module. If you have any questions or require assistance, please don't hesitate to reach out to our support team.

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Visit Your Organization's Login Page 

Begin by navigating to your organization's designated Tabulera login page.

Enter Username and Password

Once on the login page, input your username and password into the respective text fields provided and click on the "Sign In" button to proceed with the login process.

OTP Verification Popup 

Upon hitting the "Sign In" button, a popup titled "OTP Verification" will appear on your screen. This popup will prompt you to enter a one-time password (OTP) for authentication.

Check Your Email 

To obtain the OTP, check the email associated with your organization's Tabulera account. You will receive an email from client.support@tabulera.com containing the OTP. The code is valid for 5 minutes.

Login Option 1

Within the email, you will find a "Click here to login" button. Clicking this button will automatically log you into the Tabulera platform without needing to manually enter the OTP.

Login Option 2

Alternatively, you can manually copy the OTP provided in the email and paste it into the text field within the "OTP Verification" popup on the Tabulera Login Page.

Complete Login 

After entering the OTP, click on the "Verify" or "Login" button within the OTP Verification popup to complete the login process.

By following these steps, you will successfully log in to the Tabulera platform using Two-Factor Authentication (2FA), ensuring an added layer of security for your account. If you encounter any issues or require further assistance, please reach out to our support team at client.support@tabulera.com.

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‍Manual Adjustments

The "Manual Adjustments" feature provides a method for entering adjustments into the Plan Balance ledger. This feature supports retroactive adjustments (Beginning Balance) for balances prior to the conversion to Tabulera or allows for the write-off of benefit premiums.

Previous Period Resolution

This new feature allows you to resolve the current and previous month's discrepancies with just two clicks. This means users no longer have to go through each month individually to mark the plan as resolved and add a note for each month.

Platform Guide

The most recent update now includes a Platform Guide, which explains step-by-step how to upload the source data files and how to navigate and use the Benefits Reconciliation Module. It can be accessed from the User Menu in the top right corner.

Carrier Portal Links

Invoice retrieval from the carrier portal can be a time-consuming process. This new feature allows you to automatically log in to the carrier portals and avoid the copy-pasting of login credentials. The first time you access this feature, you will be redirected to the Chrome Webstore to download a Tabulera Web Password Filler Extension. Once the extension is installed, every time you hit the button next to the carrier invoice name, you will be automatically redirected to the login page, and the login credentials will be auto-completed.

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Security Improvements

2FA, or two-factor authentication, is a security measure implemented to safeguard access to the Tabulera platform. Beginning March 4th, this enhanced security feature will require every Tabulera user to provide an additional layer of authentication when logging in. In addition to entering their username and password, users will also be prompted to input a unique code sent to their registered email address.

‍Invoice Refresh

Yellow indicates that an invoice has not been uploaded

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The invoice summary page of Benefits Reconciliation version 3.1 now enables the user to regenerate the reconciliation on-demand once invoice data is entered or updated from the Sources menu.

To regenerate a reconciliation simply click the refresh icon  next to the invoice name in the invoice summary page.

Enrollment Reconciliation

Version 3.1 introduces Enrollment Reconciliation alongside our Payroll Reconciliation capabilities. Enrollment reconciliations may be useful for companies looking for a reconciliation process, even if employers are covering all benefits or before payroll data becomes available.  

To access this feature, click on the hamburger menu  at the top left of the invoice summary page and select either Payroll Reconciliation or Enrollment Reconciliation.  

Carrier Invoice Alerts

The Sources menu Carrier Invoice panel now includes new warning labels added to the invoice name column:

Red indicates that an uploaded invoice lacks plan configuration information 

Yellow indicates tha an invoice has not been uploaded 

Manually Resolved Status

The Resolution Status in the “Status” column of the Benefits Reconciliation detailed invoice panel now features several new status categories. When transactions find a match with no variances or rounding discrepancies, the system now designates these as "Auto Resolved." You may also change the status, or if you resolve an item by clicking on the “Resolve” button in the Employee View detailed panel and the item is marked as "Manually Resolved". This allows for improved tracking and auditing of how each invoice item was resolved.

Customizable Field

The Employee View detail panel now has the ability to display additional enrollment information in the form of an extra text field. It can contain any information requested by the user, such as:

• Job title
• Division/Subsidiary
• COBRA status
• Enrollment platform, etc,. 

Increased Line Items Per Page

The platform has now the ability to display up to 100 line items on a single page (Invoice or Employee view in both payroll and enrollment reconciliation).

Beginning Plan Balance Date

Our Beginning Plan Balance feature allows you to ignore data from previous periods, simplifying your reconciliation process and ensuring you start fresh when you need to. All panels and dashboard will display the plan balance information starting from the predefined date.

‍Enrollment Reconciliations

In the reconciliation process, the first step should involve aligning people and premiums with your benefits enrollment platform. This essentially requires a comparison of the plans employees have elected in your enrollment platform against what carriers reflect on their invoices. An enrollment reconciliation is an excellent first step to identify timing differences, such as new hires or terminations, for events that occur after the statement generation date. This step can be accomplished even prior to the payment of premiums.

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Payroll Reconciliations

If your company pays 100% of all insurance coverage and makes no cost sharing arrangements via payroll deductions for employees, which is rare these days, then you can skip the payroll reconciliation process. More likely your second step is to reconcile the amount of premiums employees should be reimbursing your company as the plan sponsor for any cost-sharing premium arrangements. For instance, if your company as the plan sponsor pays for 75% of the employee only premium and the employee is responsible to reimburse the plan for the other 25%, then these amounts should be reflected with the appropriate payroll deductions.  

Performing both an enrollment and payroll reconciliation assures that at the end of the day, you as the plan sponsor are not overpaying for premiums by leaving terminated employees on the invoice.  Perhaps worse yet, also double checking that employees haven’t been accidentally dropped from coverage or were missed from being enrolled.  Both of these reconciliation processes need to take into account COBRA plan enrollments and COBRA reimbursements as this can be a big benefit leakage area as well since these ex-employees may still be on the carrier invoices. 

Insurance Carrier Correction Period 

Unlike other vendor relationships, where you might find a mistake and a vendor will retroactively correct, insurance carriers usually allow only a 60 to 90 day look back period for corrections that could be attributed to the plan sponsor. This rule is not unreasonable given that carriers may be paying out claims due to the error of a plan sponsor.

Which One Works Best

Reconciling enrollment transactions to the carrier invoice is an important step before you pay your invoice but of course doesn’t ensure that your payroll platform is taking the appropriate deductions.  Payroll reconciliations maybe a better way to look at the outcome for a month but can only be completed after the coverage period month ends since payroll deductions are actively processing until the last day of the coverage month.  This puts you as the plan sponsor in a tough spot to quickly identifying and resolve discrepancies before the correction period expires.  This may be difficult if you’re a large employer with high turnover.  

The right answer maybe is to look at both processes as independent of each other that validate different steps in the Benefit Premium Administration process, the results of each reconciliation can, however, be mutually leveraged.   Using both your benefit team and your accounting teams and these two processes you should be able to provide a high level of reliability that you as the plan sponsor are covering the right people, paying the appropriate premium and receiving the right employee reimbursements.

Management by Walking Around (MBWA) is a popular management style that has been used since the 1980s to build relationships and trust between managers and employees. However, in the digital age, with remote employees, MBWA has become challenging to implement. The question is whether this style of management is still effective or not.

The Benefits of MBWA

MBWA has many benefits for both managers and employees. It allows managers to gain a better understanding of their employees' work and build relationships based on trust and open communication. It also encourages employees to be more honest and open with their managers, as they feel valued and listened to.

The Challenges of MBWA

In the digital age, implementing MBWA can be challenging. Managers cannot physically be present in the office, making it difficult to connect with employees. It also requires managers to be available at all times, which can be difficult to manage with a busy schedule.

Adapting MBWA for the Digital Age

Despite the challenges, MBWA can still be effective in the digital age if it is adapted to fit the new environment. Managers can use virtual meetings and video conferencing to stay connected with their employees. They can also use digital tools to track progress and performance. This may require some training and investment, but it can lead to streamlining manual and repetitive processes, and improve overall efficiency.

Conclusion

To ensure a successful transition, both managers and employees need to approach the change with an openness to new ways of doing things. The adaptation of MBWA to the digital age may lead to even more effectiveness and success.

What is EDI 834?

EDI 834 (ANSI X12 834) is an electronic file format designated for transmitting health plan enrollment and maintenance data. It’s officially known as the Benefit Enrollment and Maintenance transaction set. In simple terms, an EDI 834 file allows employers or other plan sponsors to exchange enrollment information about employees (and their dependents) with health insurance carriers in a standardized way. The format was introduced under HIPAA requirements – HIPAA 5010 standards mandate that all health plans must accept the ANSI 834 version 5010 format for electronic enrollments.

An 834 enrollment file typically flows from the “plan sponsor” of the insurance (an employer, PEO, union, or association) to the “payer” (e.g. insurance company or HMO/PPO). For example, a company (as plan sponsor) will send an EDI 834 file to its insurance carrier to add a new hire to the health plan or update an employee’s coverage. This standardized file replaces the need for paper forms or manual web portal entries by moving the data directly between systems (HR/payroll systems to insurance systems) in a consistent format.

Who uses EDI 834? 

A variety of organizations in the benefits space use 834 files for enrollment processing. Common senders include employers (or their HR/benefits systems) and third-party benefit administrators, while receivers are typically insurance carriers or health plan providers. Government health programs like Medicaid/Medicare also use EDI 834 to manage enrollment in public plans. In practice, this transaction set is used to handle actions such as:

New Enrollments: Adding a new subscriber (employee) and their dependents to a health plan.

Changes to Enrollment: Updating a member’s information or coverage (for instance, changing plan options or correcting data).

Reinstatements: Re-activating a lapsed or terminated enrollment for a member.

Terminations: Removing a member from coverage (e.g. when an employee leaves the company or a dependent ages out).

In essence, the EDI 834 file covers the full lifecycle of enrollment events from initial sign-ups to changes and cancellations – ensuring all parties maintain synchronized records of who is covered under a health plan.

What Information is in an 834 Enrollment File?

An 834 file is a structured text file containing many data elements that together convey the enrollment details. Each data element represents a specific fact about a member or the enrollment. For example, there are elements for a subscriber’s name, address, date of birth, plan selection, effective dates, etc.. A typical 834 enrollment file will include information such as:

• Subscriber Personal Info: Name of the employee or policy subscriber and an identifying number (such as a member ID or Social Security Number).
• Dependent Info: If dependents (spouse, children) are covered, their names and related details are included (often tied to the subscriber’s record).
• Plan and Coverage Details: The health plan or benefit plan identifiers, such as plan codes or network identifiers, indicating which plan the person is enrolling in.
• Enrollment Dates: Important dates like the coverage effective date, and possibly coverage end date if applicable.
• Eligibility and Status: Information about the member’s eligibility or any specific benefit information, as well as indicators of the action being taken (e.g. new enrollment vs. change).

All this data is encoded in the 834 file as segments of text separated by special delimiters (like asterisks * between data elements and tildes ~ marking the end of segments). Because the 834 format is standardized, each piece of information appears in a predetermined sequence, making it possible for the receiver’s system to interpret the data correctly.

Notably, whenever an enrollment file (834) is sent, the receiver will return a 999 Implementation Acknowledgment to confirm that the file was received and whether it was accepted or had any errors. The 999 acknowledgment is an automatic response that indicates if the 834 file’s structure was valid and successfully processed. (If the 834 file fails compliance checks, the 999 will report rejection or errors, which then need to be addressed by the sender.)

[[Note]]

Aside: While EDI 834 is a widely adopted standard for enrollment data, some carriers or vendors may use alternative formats if an EDI link is not in place. For instance, enrollment data might sometimes be exchanged via custom CSV files, XML files, or even API/web services in lieu of a standard 834. However, using the ANSI 834 format is generally preferred in the healthcare industry because it adheres to a common standard that all parties recognize, thus reducing miscommunication.

[[/Note]]

EDI 834 File Format and Structure

ANSI X12 834 files have a specific hierarchical structure defined by the X12 standard. At a high level, the file is organized into envelopes and records: an interchange envelope (ISA/IEA segments) wraps one or more functional group envelopes (GS/GE segments), which in turn contain the actual 834 transaction sets (ST/SE segments). Within the 834 transaction, data is grouped into logical sections often referred to as loops. Key loops in an 834 file include the header loop (often loop 1000) for information about the trading partners, a detail loop for each subscriber (loop 2000), and nested loops for related dependent or coverage details (such as loop 2300 for health coverage information).

Each loop contains various segments, which are like rows of data denoted by segment identifiers (e.g., INS, NM1, DTP). Each segment is made up of a sequence of data elements. For example, an INS segment (Insurance member detail) contains several data elements that collectively indicate whether a record is for a subscriber or dependent, the type of action (add, change, terminate), and other coverage status information. A NM1 segment (Name) contains elements for an individual’s last name, first name, middle initial, and an identification number or qualifier.

Key segments commonly found in an EDI 834 file include:

ISA – Interchange Control Header: Appears at the start of the file to identify the sender and receiver of the interchange and set control standards (e.g., delimiters). It contains routing information and control numbers for the entire file transfer.

GS – Functional Group Header: Identifies the type of transaction (in this case, BE for Benefit Enrollment) and groups all related 834 transactions in the file. It also lists sender and receiver codes and a control number.

ST – Transaction Set Header: Indicates the beginning of an individual 834 transaction set within the file (each 834 transaction has its own ST header and SE trailer with matching control numbers).

BGN – Beginning Segment: Conveys the beginning of the transaction information, including a reference code or ID for the enrollment batch and the date/time of the file’s creation. This helps identify the specific enrollment file (for example, a batch number or timestamp).

N1 – Name segments: Provide names of entities. For instance, N1*P5*... gives the plan sponsor name (e.g., the employer), and N1*IN*... gives the insurer name, along with their identification (such as tax ID or other IDs) if required. These segments clarify who the file is from and to.

INS – Member Level Detail: Denotes the start of an individual member’s enrollment record. The INS segment has elements that indicate whether the person is a subscriber or dependent, their relationship code (e.g., 18 for self, 19 for spouse, 01 for subscriber’s spouse in some codes), the type of enrollment action (such as 030 for a new enrollment or change) and coverage status (active, COBRA, etc.). This segment essentially says “here is an enrollment record for a person and here’s what is happening (add/change etc.) with their coverage.”

REF – Reference Information: Appears in various places to carry secondary identifiers. For example, a REF0F segment can carry the subscriber’s policy/account number or member ID assigned by the insurer, and REF1L might carry an alternate ID like a group number or location code. These references help match records in the carrier’s system.

NM1 – Individual Name: Provides the name of the person (subscriber or dependent) and possibly an identifying number qualifier. For a subscriber, it would typically be coded as NM1*IL (insured individual) followed by last name, first name, middle initial, and an identification number such as SSN or an internal member ID (with a qualifier like “34” indicating SSN) in the data elements.

N3/N4 – Address Segments: Give the mailing address of the individual. N3 is the street address (with two data elements allowing street line 1 and line 2), and N4 includes the city, state, ZIP code, and country. These segments appear if address information is being transmitted for the member (often for new enrollments).

DMG – Demographic Information: Contains date of birth, gender, and marital status or other demographic details for the individual. For example, DMGD819800101*M~ indicates a birth date of 01/01/1980 and gender Male. This is important for the insurer’s records of the member or dependent.

HD – Health Coverage: Specifies the details of the health plan coverage that the person is enrolling in. The HD segment can include the coverage level or plan code and coverage type. For instance, it might indicate medical, dental, vision coverage, etc., and the plan or option selected. (In some 834 implementations, multiple HD segments and subordinate segments can appear if the individual has multiple benefits like medical, dental, life insurance, etc., each in a separate loop.)

DTP – Date/Time Reference: Used to convey dates related to the enrollment. Common DTP segments in an 834 include the benefits coverage effective date (often with a qualifier like 348 = Benefit Begin Date) and possibly an end date (349 = Benefit End Date) if the transaction is terminating coverage or indicating an end of eligibility. Dates are formatted as CCYYMMDD. For example, DTP348D8*20250101~ means coverage effective date of 2025-01-01.

SE – Transaction Set Trailer: Marks the end of the individual 834 transaction and contains a segment count for that transaction for validation.

GE – Functional Group Trailer: Marks the end of the group of 834 transactions (if multiple were in one file) and includes a count of how many transaction sets were included.

IEA – Interchange Control Trailer: Closes out the interchange, providing a count of the functional groups and a final control number check.

The above segments and loops ensure that an 834 file is both comprehensive and unambiguous, but it can look quite cryptic at first glance. Here is a simple example of a snippet from an EDI 834 file, using a fictional company Daily Planet (Plan Sponsor) and an employee, Clark Kent, enrolling in a health plan:

[[Note]]

ISA*00*.........*ZZ*DAILYPLANETID*ZZ*METROPOLISHLTH*250819*1618*^*00501*000000123*0*T*:~
GS*BE*DAILYPLANET*METROPOLISHLTH*20250819*1618*1*X*005010X220A1~
ST*834*0001~
BGN*00*12345*20250819*1618*ET*4~
N1*P5*Daily Planet*FI*123456789~
N1*IN*Metropolis Health Insurer*FI*987654321~
INS*Y*18*030*XN*A*E**N*Y*Y~
REF*0F*CLARKKENT001~
REF*1L*DP-001~
NM1*IL*1*KENT*CLARK*T***34*999887777~
N3*344 CLINTON ST*STE 100~
N4*METROPOLIS*NY*10001~
DMG*D8*19800101*M~
HD*030**HLT*PLAN123*EMP~
DTP*348*D8*20250101~
DTP*349*D8*99991231~
SE*15*0001~
GE*1*1~
IEA*1*000000123~

[[/Note]]

In this example, the file headers (ISA/GS) are shown with placeholder IDs for the sender and receiver. The BGN segment indicates this is batch number 12345 created on 2025-08-19. The N1*P5 segment names “Daily Planet” as the plan sponsor (with a fictional federal ID 123456789), and N1*IN names “Metropolis Health Insurer” as the insurance carrier (ID 987654321).

The INS segment with Y*18*030 indicates an active subscriber record (Y = active, 18 = self (subscriber), 030 = enrollment maintenance code for “addition or change”) and some other flags. Two REF segments provide reference IDs: one (0F) is a subscriber identifier CLARKKENT001 and another (1L) might be a group or policy number DP-001. The NM1*IL segment gives the subscriber’s name, Clark T. Kent, and uses 34 to denote that the following number is an SSN (here 999887777 as a dummy SSN). The address is listed in N3/N4 as “344 Clinton St, Suite 100, Metropolis, NY 10001”.

The DMG segment shows Clark’s date of birth (1980-01-01) and gender (Male). The HD segment indicates the type of coverage – here “HLT” (health) with a plan code “PLAN123” and an coverage level “EMP” (perhaps Employee-only coverage). Finally, DTP348 gives the coverage effective date of 2025-01-01, and DTP349 (if present) could indicate an end date (here 9999-12-31 is often used as a placeholder end date meaning “open-ended” coverage). The transaction is closed with the SE segment, and the file is closed with GE and IEA.

Real-world 834 files can be much longer and include multiple INS loops – one for each subscriber, followed by loops for their dependents (each dependent would have INS with relationship code like 19 for spouse or 01 for child, etc., plus their own NM1, DMG, etc.). The structure and codes can also vary slightly based on each insurance carrier’s specific companion guide (for instance, some carriers might expect certain REF codes or additional segments). Nonetheless, the core layout remains as illustrated above.

Implementing an EDI 834 Interface: Team and Timeline

Setting up an EDI 834 enrollment feed is a project that typically involves both business and technical stakeholders. It’s not just an IT project – it requires understanding of benefits data and coordination with external partners (the carriers or EDI vendors). Here are key considerations for implementation:

• Cross-Functional Team: Assemble an internal team that includes benefits/HR personnel, who understand the enrollment rules and data; accounting/finance staff, who may use the data for billing reconciliation; and IT/EDI specialists, who handle the technical mapping and connectivity. This mix ensures that when decisions arise (like how a particular plan code should be represented, or how to handle specific business rules), the right experts are involved. Each insurance carrier will usually provide an EDI companion guide (sometimes called an EDI “structure” document) describing exactly how they implement the 834 format. Your team will need to review this guide in detail to configure your output file to the carrier’s specifications.
  
  
• Mapping and Development: The IT/EDI specialist (or EDI software) must map data from your source system (e.g., HRIS or benefits administration system) into the 834 format according to the carrier’s requirements. This includes mapping your internal fields (like employee ID, plan selections, dependent info) to the appropriate segments and elements in the 834. Often this involves using an EDI translator or middleware that can be configured with the rules. If you’re using a third-party EDI 834 or software like Tabulera’s EDI 834 Module, they might handle much of this mapping for you once you provide them the data specifications.
  
  
• Testing with Carriers: Testing is crucial before an 834 feed goes live. Typically, you will exchange test files with the insurance carrier’s EDI team. They will validate that the file is formatted correctly and that their system can ingest it. This often uncovers issues like mismatched codes or missing required data, which need to be corrected. Only after you pass the carrier’s test scenarios (which may include cases for adding new enrollments, making changes, and terminating coverage) will the carrier approve moving to production. This testing phase ensures that when you send real enrollment data, it will update the carrier’s system without errors.
  
  
• Timeline: The time it takes to implement an EDI 834 interface can vary widely. It depends on factors such as the carrier’s responsiveness, the complexity of your plans, and the availability of resources. Generally, the analysis of the carrier’s EDI requirements, building the file, and end-to-end testing can take anywhere from a few weeks to a few months. Industry experience shows a range around 3 to 12 weeks for a typical 834 implementation project, from project kickoff to go-live. More straightforward cases (single plan, using a modern EDI platform) might be on the shorter end, whereas complex scenarios (multiple carriers, custom business rules) lean toward the longer end. Tabulera gets the EDI files live in 30 days.
  
  
• Resource Considerations: During implementation, your team will need to dedicate time to meetings with the carrier (or EDI vendor), data mapping exercises, and iterative tests. Make sure to budget sufficient time for your IT staff to work on file development and for your benefits staff to validate that the enrollment information is being transmitted correctly (e.g., verifying that enrollments in your HR system match what appears in the carrier’s test system after they process the 834). The process often involves a lot of back-and-forth communication to get everything “just right,” so patience and attention to detail are important.

One thing to keep in mind is that each insurance carrier has its own nuances. If you are implementing 834 feeds for multiple carriers, you will repeat this process for each one, since each carrier’s companion guide might differ slightly (different required fields, different code values allowed, etc.). However, once the initial setup is done and working, adding new hires or changes via EDI becomes much less labor-intensive than manual entry.

Ongoing EDI 834 Exchange: Cadence, Monitoring, and Maintenance

Once your EDI 834 feed is live, using it becomes a routine part of your benefits administration process. Typically, companies will send enrollment update files on a regular cadence (schedule). Common schedules are weekly transmissions (e.g., every Friday) or per payroll period, so that any HR changes (new enrollments, terminations, etc.) from that week are sent in batch to the carrier. Some may send files daily if volume is high or if needing near-real-time updates (for example, some systems can trigger an 834 file generation whenever a change is made). The schedule is usually agreed upon with the carrier in advance.

Files are usually transmitted through secure channels – often via SFTP (Secure FTP) or another secure file transfer service – to protect the sensitive personal health information contained in the 834 (since these files have names, SSNs or IDs, birthdates, etc., they must be handled in a HIPAA-compliant manner). The transfer process can be automated so that files are sent and received without manual intervention. For instance, your system might drop an 834 file to a secure folder every Friday, and the carrier’s system automatically picks it up for processing.

Monitoring acknowledgments: As mentioned earlier, you should expect a 999 acknowledgment in return for each file, usually within minutes or a day of the file delivery (depending on the carrier’s system). It’s important to check these 999 responses. An accepted 999 means the file structurally passed; a rejected 999 means nothing was processed – you’d need to fix the error (e.g., maybe an invalid date format or a missing required segment) and resend. Having alerts or notifications for failed acknowledgments is a good practice.

Discrepancy reports: In many cases, after processing the file, the carrier may provide a response report or error/discrepancy report that details any enrollment records from your 834 that could not be applied. For example, if one of the records in the 834 had a problem (like a dependent listed without a date of birth, or an employee not found in the carrier’s system), the carrier’s system might accept the file but note those issues on a report. It’s typically the responsibility of the sending entity (your team or your EDI vendor) to review these discrepancy reports each time and resolve any issues. Resolving issues might involve correcting data in your HR system (and then that correction will flow in the next 834 file) or manually informing the carrier of adjustments if needed.

It’s important to assign an owner for this ongoing process. Usually, the benefits or HR team will be the ones who understand the data and can fix it. They should know how to read the carrier’s report or have a tool to interpret it, since it often references members by IDs or error codes. Maintaining this process diligently is imperative to keep everything in sync – coverage accuracy depends on continuously addressing any errors that come up. If errors are left unresolved, an employee might think they’re enrolled when the carrier actually didn’t activate their coverage, leading to unpleasant surprises at the doctor’s office. Thus, having controls in place (like a checklist to verify each weekly file was sent and accepted, and each discrepancy report was reviewed) will ensure the EDI feed continues to deliver value.

Changes and updates: Over time, you may need to update your 834 feed. Perhaps you add a new benefit plan (which means new codes to send), or your company changes payroll/HR systems, or the carrier updates their companion guide for a new version of the standard. EDI 834 is not “set and forget” – it may require periodic maintenance. Upgrading from one version to another (like from 5010 to future versions) could be a project with the carrier. Always communicate with carriers if you plan changes on your side that could affect the file (for example, if you’ll start sending new deduction codes or if you acquire another company and suddenly have a spike in enrollments).

Reading and Troubleshooting EDI 834 Files

For IT professionals familiar with EDI, an 834 file is straightforward to parse with the right tools or EDI software. However, for benefits administrators or others who are not EDI experts, the file’s raw format is hard to read. Each segment code and cryptic value needs interpretation. So how do you “read” an EDI 834 if you need to verify something?

Understanding the structure: If you open an 834 file in a text editor, you’ll see the segments separated by tildes (~). The first thing is to identify the sections. Look for the ISA and GS at the top – these tell you the sender/receiver and that you indeed have the right file (834). Next, find the ST*834 segment which marks the start of the actual enrollment data transaction. Everything between ST and the matching SE is one complete 834 transaction set. If multiple ST...SE segments exist, there are multiple transactions in one file (which is less common for enrollment files – usually it’s one transaction listing multiple members).

Key segments to review: Within the transaction, you’ll want to pinpoint certain segments for the information you need. The BGN segment can tell you the batch number or purpose of the file (for example, some might use a code to indicate if it’s an initial load vs. ongoing maintenance). The INS segments mark each member record, so scanning for "INSY" or "INSN" helps you locate the start of each person’s data. The INS will also tell you if that person is a subscriber or dependent (relationship code) and if the record is adding, changing, or terminating coverage (maintenance type code). Right after an INS, you should see that person’s NM1 (Name) segment and associated details like REF (IDs) and DTP (dates). By reading the NM1 and related segments, you can extract the member’s name, their identifying numbers, coverage effective dates, etc.. For instance, to find if a specific employee (say John Doe) was included in the file, you might search the text for "DOE*JOHN" which would appear in the NM1 segment for that person.

Extracting specific data: If you are looking for a particular detail, such as the effective date of coverage for an employee, you would navigate to that employee’s INS loop and find the DTP segment with qualifier 348 (Benefit Begin Date) within that loop. Or if you need to verify what plan they were enrolled in, find the HD segment in their record which might contain the plan code. Addresses will be in N3/N4 following the NM1 if present.

Checking file integrity: Toward the bottom of the file, verify the SE segment count matches the actual number of segments in the transaction and that the GE and IEA control numbers match the ISA/GS. This is more of a technical check, but it ensures the file isn’t truncated or missing segments. An issue in these can indicate the file was incomplete.

Tools for easier reading: Because manually reading raw EDI is tedious and prone to misinterpretation, many organizations use EDI parser tools or have their EDI vendor provide a human-readable version of the 834.

For example, some tools can convert the 834 into a CSV or a nicely formatted report listing each member and their data fields. In our case, we’ve introduced a feature called Member Search that translates EDI 834 files into easily understandable data, allowing even non-technical users (like brokers, call centers or HR teams) to quickly look up an employee or dependent and see their enrollment info without sifting through raw EDI lines. This kind of tool can answer questions like “Is this employee’s new enrollments in the latest file?” or “What dependents were included for this employee?” by simply searching for the member’s name or ID. Member Search essentially parses the EDI behind the scenes and presents the relevant information in plain language, which is a huge time-saver for benefits teams who need quick answers from the EDI feed.

If you don’t have an automated tool, another strategy is to refer to the carrier’s companion guide while inspecting the file – the guide will define each segment and element so you can decode what each line means. Over time, as you become familiar with the 834 structure, you’ll get better at eyeballing common segments and understanding them.

Benefits of Using EDI 834 for Enrollment

Implementing EDI 834 for benefits enrollment can require effort up front, but the payoff is significant. Key advantages include:

• Efficiency and Speed: EDI automates the transfer of enrollment data that would otherwise be entered manually. This cuts down on the repetitive data entry work of logging into carrier websites and typing in each new hire or change. A properly functioning 834 feed means that when you update your HR system, those updates are compiled and sent out automatically. The result is faster updates to coverage – employees get enrolled or changes processed in days instead of weeks.
• Reduced Errors: Manual data entry is error-prone – typos or missed fields can lead to coverage mistakes. The 834 file format minimizes these errors by taking data directly from your source system and standardizing it. While errors can still occur (for example, if the source data is wrong), there’s no risk of human transcription mistakes during submission. Additionally, the structured format validates the data (e.g., a date field will clearly show if a date is missing or misformatted, triggering a correction before it loads). Overall data accuracy improves, leading to fewer discrepancies between your records and the carrier’s records.
• Consistency and Compliance: Because the 834 is a national standard, it enforces a level of consistency in how enrollment data is communicated. This helps ensure compliance with regulations (HIPAA, ACA reporting requirements, etc.) since you’re using the approved format for data exchange. It also means if you switch to a new carrier or benefits administrator, they will likely accept the same 834 format, making transitions smoother.
• Rich Data and Custom Fields: The 834 format isn’t limited to just the basics of enrollment; it allows transmission of a variety of data elements. For example, you can include departmental codes, division identifiers, or job class info in the 834 (often via REF segments or other optional fields). These additional fields can later show up on your carrier’s premium invoices or reports. That means you can get more detailed billing breakdowns (e.g., premiums by department) without manual effort, simplifying accounting reconciliation.
• Improved Employee Experience: When enrollments are processed quickly and accurately, employees experience fewer issues like missed coverages or ID card delays. There are fewer panicked calls from employees at a pharmacy saying “My insurance isn’t active.” This improved reliability leads to fewer employee complaints about benefits. Also, your benefits team shifts from tedious form-filling to an oversight role – they spend time on verification and exception handling rather than typing data. This elevates their job satisfaction and lets them focus on higher-value tasks like analyzing benefits utilization or improving communication, instead of being stuck in data entry mode.
• Scalability: As your organization grows, the volume of enrollment changes grows too. An electronic process scales far better than a manual one. Whether you’re adding 10 new hires or 1,000 new hires, the 834 file process is largely the same automated flow. This scalability is crucial for fast-growing companies or those that experience seasonal enrollment spikes. It also becomes indispensable if your company goes through mergers or adds new groups – instead of overwhelming your benefits staff with administrative work, the EDI can handle the surge as long as the data is fed into it.

In summary, using EDI 834 drives efficiency, accuracy, and timeliness in benefits administration. It aligns with the digital transformation of HR processes – moving away from paper forms and isolated systems toward integrated data exchange. When combined with proper controls and monitoring, an 834 feed significantly reduces the administrative burden and the risk of coverage errors.

Challenges and Best Practices

While the benefits are clear, it’s also important to acknowledge challenges and share some best practices when handling EDI 834 files:

• Data Readiness: EDI will only send what data you have. One common challenge is ensuring your HR system or enrollment platform has all the required information to populate the 834 file. Missing data (like a missing date of birth or SSN for a dependent) can cause rejections. Best practice is to enforce required fields in your source system and run data audits before sending the file. For example, run a report of all employees with missing key fields prior to go-live.
• Carrier Variations: Each trading partner might have slight differences in how they implement the 834. One insurer might require a value that another does not. Maintain a mapping documentation for each carrier’s feed that notes these specifics. This becomes vital for troubleshooting issues because you can refer back to what each carrier expects. If possible, use a flexible EDI solution that allows you to handle variations through configuration rather than hard-coding, so updates are easier.
• Testing Changes: Whenever you or the carrier makes a change (for instance, you add a new field to the 834, or the carrier updates their system), conduct regression testing. Send test files and have the carrier confirm all is well. Do not assume that a change is minor; even a small tweak can have unintended effects on file processing.
• Monitoring and Alerts: Establish a monitoring mechanism for your EDI process. This could be as simple as an automated email confirming file sent and 999 received, or as robust as an EDI dashboard that flags errors. The key is, you want to know if something goes wrong before it becomes a big problem. For instance, if a weekly file fails to send, an alert should notify IT to resend it or fix the issue immediately, rather than discovering a month later that a batch of enrollments never went through.
• Security: Always send EDI 834 files securely. Use encryption (PGP encryption on the file, for example) if required in addition to secure channels. Ensure that only authorized personnel have access to these files, as they contain protected health information. Work with your IT security team to include EDI in your data protection policies.
• Backup Processes: Have a contingency plan in case the EDI process encounters a prolonged issue. For example, if your EDI system is down or a critical error is preventing file transmission for a few cycles, you might need to fall back to manual entry on the carrier’s portal as a temporary stop-gap. Knowing how you will handle that scenario (and how to catch the carrier data up with a big file later) will save stress if it ever happens.

By being mindful of these challenges and proactive with best practices, you can ensure your EDI 834 integrations run smoothly and continue delivering value over the long term.

How to Cut EDI 834 Implementation Time to Just 30 Days

One of the biggest struggles with EDI 834 is simply getting files live. In the industry, even a basic setup—one HRIS or payroll system connected to one carrier—often takes 3 to 6 months. When multiple feeds are involved, it can drag on for a year or more. Some organizations even spend close to two years trying to implement a single file before finally seeking outside help.

Working with the right EDI 834 vendor changes that experience. Tabulera gets EDI 834 files live in about 30 days, helping employers, brokers, and outsourcers avoid long delays and stalled projects. Beyond implementation speed, the EDI Connectivity Module provides transaction tracking, scheduling, and Member Search to make ongoing file management and troubleshooting easier.

Employee benefit plans are an essential part of any organization. As an employer, you need to ensure that your employees receive the benefits they deserve, and one of the critical factors is paying the premiums on time. This is where list-billing and self-billing come into play.

What is List-Billing for an Employee Benefit Plan?

List-billing is a process where the insurance carrier generates an invoice for premiums and sends it to the employer. The data for the invoice is taken from the enrollment system, which may be manually entered into a carrier website, or larger employers may transmit the data directly to the carrier. The employer is responsible for paying the amount stated on the invoice to settle the transaction. Insurance companies usually publish the list-bill on their website.

What is Self-Billing for an Employee Benefit Plan?

Self-billing is a financial arrangement between the employer and the insurance carrier, where the employer creates an insurance premium invoice and sends it to the carrier along with the backup detail information. The data to create the invoice is usually derived from the employer's benefit enrollment or payroll system. The employer is then responsible for paying the amount stated on the invoice they created to settle the transaction.

What's the difference between Self and List Bills?

The main difference between self-billing and list-billing is who creates and sends the invoice. In self-billing, the employer creates and sends the invoice, while in list-billing, the insurance carrier creates and sends the invoice.

Comparing the Reconciliation Processes of List-Bills and Self-Bills for Employee Benefit Plans

The reconciliation process also differs between list-billing and self-billing. With a list-bill, the employer needs to note any variances in timing that occur for new hires or terminations after the statement generation date and the enrollment and/or payroll system to ensure these are resolved on the following month's invoice. Differences in premiums between the enrollment and payroll systems may also occur due to carrier invoicing calculation errors or configuration of payroll deduction and/or plan enrollment premium tables.


While self-bills may eliminate enrollment and termination timing differences, they do not eliminate system configuration errors, such as lack of payroll deductions, leaves of absence, missed first or last deductions from partial months of employment. Moreover, self-bill programming or spreadsheets may introduce calculation errors given the complexity of eligibility and possible wash rule algorithms. The benefit or accounting team may be unaware that these errors even exist if premiums are not reconciled against a third-party invoice.

Conclusion

In conclusion, both list-billing and self-billing have their pros and cons. With list-billing, the carrier creates an invoice documenting what they believe the employer owes, and the employer can validate it against their own systems. With self-billing, the employer can eliminate timing differences, but it leaves them guessing what rates the carriers attach or when rate increases may take effect for their plans. Regardless of which billing method an employer chooses, monthly invoice auditing against their enrollment, payroll, and their invoices is a sure way to avoid surprises.

Key Point #1:
The Perils of Multiple Systems with Manual Configuration

Many employers utilize separate enrollment and payroll systems, alongside manual data entry processes for COBRA and emergency enrollments. These disparate systems can create a perfect storm of confusion and inefficiency, leading to costly errors.One of the main issues is that these systems are often maintained by different teams. Each team might have varying levels of expertise, experience, and commitment to maintaining the quality of the system. This inconsistency can lead to data discrepancies, making it difficult to reconcile even one set of systems, let alone multiple sets.Furthermore, these systems don't only differ in how they handle employee names and identifying information. They can also have different names and descriptions for the same plans and benefits, causing even more confusion when trying to match records across systems.


In this illustration, we demonstrate the discrepancies that can arise when the same employee and plan are represented in three different systems:

‍

Enrollment system

‍
First name: Ken
Middle name: P.
Last name: Lee
SSN: 1234********
Plan Name: OAMC 500
Plan Description:
ER Funded Short-Term Disability-Employee Only

Payroll system

‍
Employee Name: Kenneth Peter Lee
SSN: (NOT AVAILABLE)
Plan Name: AETNA-OAMC-500/80-NB
Plan Description: STD
Deduction amount: $80.74
Pay Frequency: Bi-Weekly

Carrier Invoice

‍
Employee name: Lee, Ken P.
Plan Description: STD Cigna
Tier: EMP+Family
Rate: $161.48

‍

This example highlights the inconsistencies between different systems in terms of naming conventions, plan descriptions, employee names, and the availability of key data like Social Security Numbers. These discrepancies can make benefit plan reconciliation challenging, emphasizing the need for effective tools and processes to improve accuracy and efficiency.

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Key Point #2: The Responsibility Conundrum

Determining who should be responsible for preventing benefits billing errors is a challenge. In many instances, reconciliation is ignored by both the benefits and accounting teams. This lack of accountability can lead to costly mistakes and lost benefits dollars.

Benefits teams often find themselves understaffed and overworked, trying to manage complex benefits processes with limited resources. They usually rely on Excel spreadsheets, which, while useful, have their limitations when it comes to handling complex benefits processes. As a result, it's difficult for benefits teams to come up with a formula that can match records across disparate systems, leading to errors and inefficiencies.

Accounting teams, on the other hand, may not have the specialized knowledge required to handle complex benefits processes. They may also lack access to HR systems, which can result in errors and inefficiencies when it comes to benefits billing and reconciliation.

The Numbers: A Closer Look at Lost Benefits Dollars

Our analysis revealed an average of $6.47 per employee per month in premium write-offs during the first quarter. This may not seem significant initially, but multiplying it by the number of employees demonstrates the true impact:

One quarter: $6.47 x 21,182 = $136,944

Pre-Tabulera numbers:
Total Benefit Write-Offs: $136,944
Benefit Premium Write-off: 0.79%
Benefit Premium Processed: $17.4 million
Employees per Quarter: 21,182

These numbers reveal the hidden costs of inefficient benefits billing process. Over time, these costs can add up and significantly impact an organization's bottom line.

Addressing the Problem: Implementing Consolidated Invoicing and Benefits Reconciliation

To combat these issues, we introduced two modules for our clients: Consolidated Invoicing and Benefits Reconciliation. These modules were designed to streamline the benefits billing process and reduce the likelihood of errors and inefficiencies.

The Consolidated Invoicing module combines carrier list bills and generated self-bills into a single monthly invoice. This simplifies the invoicing process and frees up Accounts Payable staff from having to manage and pay multiple invoices each month. By consolidating invoices, the module also makes it easier for accounting teams to track benefits spending and ensure that payments are made on time.

The Benefits Reconciliation module filters out timing differences and identifies potential system misconfigurations. This allows the Benefits team to focus on employees who require attention and helps prevent billing errors. The module automates much of the reconciliation process, flagging issues such as:

• Employee terminations that are still being invoiced
• Deductions from employees who aren't present on an invoice
• Rate differences between payroll, enrollment, COBRA, and carrier invoices

By automatically categorizing these variances and calculating self-bills, the Benefits Reconciliation module enables HR teams to address discrepancies more efficiently.

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‍

The Impact: Substantial Time and Cost Savings

By the third quarter, most clients had reduced their premium write-offs to about $0.22 per employee per month, a 97% reduction. This demonstrates the powerful impact of implementing consolidated invoicing and benefits reconciliation on an organization's bottom line.

Despite some residual write-offs due to varying implementation timelines and delayed reporting of terminations, the overall impact was significant. The case study covered multiple employers that were not implemented at the same time, which may have contributed to some of the remaining write-offs.

Benefits reconciliation can introduce substantial time and cost savings by allowing HR teams to focus on analyzing variances instead of manually checking every employee's information. This can reduce the labor-intensive aspect of the process by up to 90%, freeing up HR professionals to focus on other important tasks.

Let's take a closer look at the complete timeline. By analyzing the data over two years, we were able to track the progress of our clients' benefits billing processes. In the beginning, premium write-offs were a significant issue, causing unnecessary financial strain on the organizations. However, as the clients implemented the Consolidated Invoicing and Benefits Reconciliation modules, the write-offs began to decrease dramatically.

By Q3, most clients had normalized their Write-Offs of premiums to about $0.22 PEPM, effectively eliminating the issue for many employers. This demonstrates the power of implementing efficient benefits billing processes and tools, which can help organizations save valuable resources and improve their bottom lines.

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Conclusion

Inefficiencies in benefits reconciliation can lead to lost dollars for employers, negatively impacting their financial health. By addressing the challenges posed by disparate systems, manual processes, and lack of accountability, organizations can save valuable resources and ensure accurate benefits billing.

Implementing Consolidated Invoicing and Benefits Reconciliation can have a significant impact on an organization's bottom line, reducing premium write-offs by up to 97%. With the potential for substantial time and cost savings, these tools should be considered by any organization looking to streamline their benefits reconciliation process and eliminate unnecessary expenses.

If you know someone who is tired of wrestling with spreadsheets and dealing with the headaches of inefficient benefits reconciliation, please share and repost this analysis to spread awareness about the potential benefits of implementing consolidated invoicing and benefits reconciliation. By shedding light on the hidden costs of employee benefits reconciliation and sharing solutions to address these challenges, we can help organizations save money and better support their employees.

Home Dashboard review

Log in to the Tabulera Portal and access the Home Page, offering an overview of key metrics related to your employee benefit plans. The user-friendly and intuitive design of the Home Page facilitates easy navigation through various features of the Tabulera platform.

The Home Page dashboard presents statistical information on the left and financial details on the right, complemented by a navigation bar along the top. 

Our primary focus will be on the Sources and Benefits Reconciliation links in the main menu.

Let’s walk through a step-by-step process that starts with uploading the source data files, then reconcile an insurance carrier invoice and look at our reconciliation reports.

Upload Source Data Files

Sources menu

Uploading the relevant source data is the first step in reconciling employee benefit plan invoices using the Tabulera platform. This is a crucial step in ensuring that accurate data is used to reconcile the invoices. The type of source data that needs to be uploaded includes enrollment data, payroll data, COBRA data, and carrier invoices.

At the top of the page, you’ll notice a Date Ribbon for your coverage periods and along the left navigation menu we have the four data sources we need to load to complete a reconciliation. These data sources include your enrollment, payroll, COBRA and your carrier invoice data.

Enrollment Data Upload

Let's kick off the data upload process by focusing on the enrollment file. Click on the "Re-upload" button and select the enrollment report file from your local computer. It's crucial to ensure the file is accurate and reflects the most up-to-date information for the respective period.

Payroll Data Upload

After managing the enrollment data, navigate to the payroll menu. Click on "Add File" to upload the payroll report specifically for January 2024 from your local computer. Once this upload is complete, proceed to the subsequent month, February 2024, and repeat the same procedure. Verify that each payroll report aligns seamlessly with its corresponding month.

Invoice Upload

Next, for the purpose of demonstrating how to resolve timing discrepancies we will upload two invoices, one for January and another for February 2024. Locate the Daily Planet – UHC invoice and click on the "Upload" button next to it. Then, locate the respective invoice in your local file system, downloaded previously from the insurance carrier website, and click "OPEN." Observe the status of the invoice changing to "Processing," soon transitioning to "Completed," indicating the successful upload. Repeat this process for the February 2024 invoice.

Congrats, we have successfully uploaded the source data and that we can move to the Benefits Recon Menu.

Start the Reconciliation Process

In this demo example, we will reconcile payroll deductions and employer contributions to the carrier invoice to look at any variances between these data sources and ensure we understand why the variances exist, add any adjustments, or notes to complete the reconciliation.

A dashboard at the top of the page summarizes progress on your current month's reconciliations.

The panel below displays a list of invoices, with columns indicating the invoiced amount for carrier premiums and another column reflecting the payroll amount, including employer contributions for the month. Additional columns indicate instances where you may have over-collected from certain employees compared to the invoice, as well as a column designating under-collected amounts from employees compared to the invoice. These columns usually represent timing differences for new hires and terminations. We also show the cumulative amount for each invoice variance over time in the Plan Balance column.

Since the invoices for Daily Planet have recently been uploaded - we have to click the 'Regenerate Reconciliation' button next to the invoice name.

Let’s click on the Daily Planet UHC invoice line to look at the invoice line-item details.

On the Details Page, you’ll see columns for Employee Name, Plan Type, Carrier Plan Name, the Invoice Amount, Payroll Amount, and columns for Resolution Adjustments, Resolution Reason, and a variance column for the month and a variance column for the Plan to Date. You’ll notice that one Resolution Adjustment for Rounding has already been made for our Employee “Clark Kent”.

Rounding discrepancy

If you click on his line item, you will see a panel for Clark Kent with detailed demographic data that pops out from the right, along with a history of transactions including Payroll Deductions, Employer Contributions, and Carrier Invoices, as well as a running Plan Balance for each month. The Plan Balance is expected to be zero every month, calculated as the sum of Payroll Deductions and Employer Contributions minus Carrier Invoices.

When invoices and payroll are uploaded each month, the system automatically assigns a variance reason. These reasons are helpful in categorizing possible variance causes such as rounding, timing, or configuration issues.

If no variance exists for an employee between the premium amount on the carrier invoice and monthly payroll deduction and employer contribution, the system will automatically mark the employee line items as “Auto Resolved” for the month. As you can see in the Plan Balance view, the Rounding Adjustment has been generated by the system for Clark Kent based on the company rounding rules configured during implementation.

Most transactions can be Auto Resolved by the system, but Manual Adjustments may be necessary in certain cases. Let’s examine a few of these cases.

Click on the “Filter Funnel” at the top of the Status column to filter for only those transactions that are “Unresolved”. You'll notice four transactions marked with a red dot and a status of 'Unresolved'.

Rate Differential: Beginning Plan Balance

Let's click on the first employee in the list, Jimmy Olsen.

You'll notice that he appears to be a new hire, having been onboarded on November First, 2023. If we take a closer look at his coverage start date in the detailed view, it began on December First, 2023. The carrier is billing Daily Planet for coverage retroactively for a month, as indicated by the doubled premiums billed in January.

Since January 2024 is the first time Daily Planet has been reconciled on the system, we’ll Click on Add Manual Adjustment and create a beginning balance to Jimmy’s Plan Balance in the amount of $374.82, since we don’t have any payroll deduction transaction history prior to January 2024 for the Daily Planet. This lets the system know that this is a reconciling entry for January, and the balance is recorded in both the Carrier and your systems.

You’ll now notice that as the entry is made the employee’s Plan Balance becomes zero to correctly show the running balance for Jimmy’s medical plan and that the item has been marked as “Resolved”. The Resolution Adjustment and Resolution Reason columns are also updated, along with the Over and Under Collected Amounts and Item Resolved counts at the top of the page.

Rate Differential: Write-Off

We'll click on the next employee with a red dot and a status of 'Unresolved' - Lois Lane.

By examining Lois's details page, it appears she was hired in the last half of January 2024 and only had one payroll deduction for medical insurance premiums.

We'll click on 'Add Manual Adjustments' under the Plan Balance view, Use the January Coverage Period, select the 'Write-off' reason, and enter $35.32 to record the write-off per the company policy. This once again shows the employee with a balance of zero and the item with a 'Manual Resolved' status.

The Resolution Amount, Resolution Reason column information, and top-of-page metrics have also been updated to reflect your progress.

Enrollment in transit

Next, we'll click on Perry White as he has an 'Unresolved' status as well. Perry is also a new hire with a Payroll Deduction Amount but hasn't yet shown up on the carrier invoice (You can notice a missing premium in the section highlighted in red). The system has automatically marked him in this status as 'Enroll In Transit.'

You can validate his hire date and details, but also notice, since the February invoices have already been uploaded, that the Carrier has retroactively billed for January. We'll click on 'Manually Resolved' for January with no manual adjustments necessary, as we see his plan balance is zero by February 2024.

Termination in transit

Finally, we’ll Click on Steve Lombard as his Status is also “Unresolved” with a Variance Reason as “Term In Transit”. Steve looks to be a late December termination and we, in fact, see that in February the carrier has provided the credit to refund the January Premium showing Steve has a zero Plan Balance. We can mark Steve as “Manually Resolved”.

At the top of the page, the Over Collected, Under Collected Beginning and Resolved Amounts, and Beginning and Resolved Item Counts equal each other, indicating we have completed the reconciliation of the Daily Planet’s UHC January Invoice.

Reports

The Report button has been moved to the bottom of the screen in the latest update. Clicking it reveals several reporting options, depending on the scope:

Company-Wide Reports

These cover data across all invoices:

• Plan Balance Report
  Shows total plan costs by employee over a given period. You can break it down by carrier or by company.
• Invoice Resolution Statistics
  See how well the platform auto-matched employees. It’s a good way to confirm your plan configuration is working correctly.
• Manual Adjustments Report
  Lists any manual entries made to adjust plan balances. Useful for finance or audit teams.
• Activity Report
  A full log of all actions taken by users in the system. Every step is recorded.

Invoice-Specific Reports

These are tied to the invoice currently being reviewed:

• Benefits Reconciliation Report
  Shows the total carrier invoice amount and any Manual Adjustments made to match it. This report also highlights any in-transit items and is typically shared with your Accounting Department for reconciliation or GL entries.
• Source Report
  Exports all raw source data linked to the current invoice.
• Activity Report
  Shows user actions specific to this invoice—what was done, when, and by whom.

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Conclusion

In conclusion, by following these simple steps, you can easily reconcile employee benefits plan invoices using the Tabulera Portal. The platform's user-friendly interface and straightforward upload process make it easy to quickly and accurately reconcile employee benefits against both your enrollment and payroll information.

Don't forget to check our Case Study, where we show How we saved $531.742 to our group of clients by eliminating benefit write-off's with our Benefits Reconciliation Module.

If you're an employer with fewer than 500 employees, there's an easy way to get started—sign up for a 30-day free trial and see how Tabulera can streamline your benefits reconciliation process from day one.