Reconciliation of Individual Medicare Benefits on Sponsor Account

Until now, the system enabled you to reconcile payable pay instructions of the sponsor account against the bill line items and thereby ensure that the discrepancy is identified and resolved on time. Now, the system enables you to reconcile Medicare benefits which may be payable or non-payable by the sponsor. In other words, you can reconcile payable and non-payable pay instructions of the sponsor account against the bill line items and thereby ensure that the discrepancy is identified and resolved on time. The non-payable pay instructions can be reconciled against memo only or non-memo charges depending on whether the membership benefit is memo only or not.

To implement this feature, the following changes are made to the system:

• The Payable column is available while mapping a payment type to a price item in the C1-PayTypePrcItemMap extendable lookup value.

• The Payable field is added in the Pay Instructions zone of the Pay Instruction tab in the Reconciliation screen.

• The C1-RCPM and C1-RCNMD batches are enhanced to support non-payable pay instructions in the reconciliation object.

• A new parameter named Payment Type – Price Item mapping is added in the C1-CRDSLNITM algorithm type.

• Two new discrepancy categories - Record Not Found in the File and Record Not Found in the System are introduced to accurately classify the non-payable pay instruction discrepancies.

Once you upload a pay instruction file which contains payable and/or non-payable instructions, the system determines whether a pay instruction is payable or non-payable using the C1-PayTypePrcItemMap extendable lookup value while creating a pay instruction. Once the pay instructions are created, you can filter and view the payable and non-payable pay instructions of a reconciliation object in the Pay Instructions zone.

While specifying the payment against which you want to reconcile the bill line items for which you have received the pay instructions, you must ensure that the payment amount is equal to only the amount of payable pay instructions. On reconciling a non-payable pay instruction, the system will check whether the membership benefit is memo only. If the non-payable membership benefit is not memo only, the system reconciles the pay instruction against the financial transaction. And, if the non-payable membership benefit is memo only, the system reconciles the pay instruction against the bill line item. However, note the system does not create a reconciliation adjustment for a non-payable pay instruction when it is successfully reconciled.

The system enables you to view the reconciliation discrepancy report at the file or account level for the payable as well as non-payable pay instructions.