Reconciliation Discrepancy Report of Individual Health Insurance Subsidy Payments

Until now, you were able to generate the reconciliation discrepancy report at the file or account level for the fully insured group business. Now, in addition, you can generate the reconciliation discrepancy report at the file or account level for the individual health insurance subsidy payments. If you generate the discrepancy report at the file level, the system lists the following:

  • All pay instructions in the file which were partially reconciled due to rate variance

  • All pay instructions in the file which could not be reconciled as the amount was paid, but not yet billed

However, if you generate the discrepancy report at the account level, the system lists the following:

  • All bill line items which were partially reconciled against pay instructions due to rate variance

  • All bill line items which could not be reconciled as the amount was billed, but not yet paid

  • All pay instructions for the account which could not be reconciled as the amount was paid, but not yet billed

While generating a discrepancy report, you need to specify the discrepancy report type using which you want to create the discrepancy report. The system will create the discrepancy report in either Pending or Deferred Processing status. Once you review the discrepancy line items and finalize the discrepancy report, its status is changed to Completed.

At a time, you can only have one discrepancy report for a file or an account in the Pending or Deferred Processing status. Until you finalize a discrepancy report, you cannot create another discrepancy report for the respective file or account. Also, note that you can create a discrepancy report for a file only when its corresponding reconciliation object is in the Open status.

When you generate a discrepancy report for a pay instruction file which is received from the exchange or when you generate a discrepancy report for an exchange account, the system displays the following additional information for each discrepancy line item along with other details:

  • Payor Identifier Type

  • Payor Identifier

  • Health Plan

  • HIOS ID

  • Payment Type

Note: Policy number and plan number are displayed instead of the above information when you generate discrepancy report for the fully insured group business.