Reconciling a health insurance commission statement in under 15 minutes a month

Start from your book, not from the statement

Most agents open the statement and read down the page. That can only find errors in lines that exist. The expensive failure — a policy in force that produced no line at all — is invisible from that direction.

Work the other way. Start with every active policy you should be paid on this period, then ask whether each one is on the statement. Anything unmatched is either a termination you were not told about or money you are owed.

The four questions

For each line that does exist, four questions cover nearly every underpayment worth chasing:

• Is the basis right — percentage of premium, flat fee per member, or a CMS per-member amount?
• Is the rate or amount the one in your agreement, and is new versus renewal coded correctly?
• Is the member or premium count the same as your record?
• Does any negative or adjustment line match a payment you actually received earlier?

Make it a habit with a deadline

Carriers generally limit how far back they will adjust. A finding raised in the month it happens is routine; the same finding raised nine months later becomes a negotiation. A fixed monthly slot — the day the statement lands — is worth more than a thorough audit once a year.

Loading the statement file and letting the arithmetic run turns the routine into a few minutes: the lines that agree disappear, and what is left is the short list worth an email to the carrier.