Commission Guardian

Health & Medicare

Commission audit software for health and Medicare agents.

Every statement checked. Every short payment found.

Medicare Advantage and Part D pay per-member amounts capped by CMS, Medicare Supplement pays a percentage of premium, and ACA plans usually pay a flat fee per member, often all on one statement. Commission Guardian checks every line against the right rule, with full CMS amounts built in (or your own percent or flat rate), and flags anything short, missing or clawed back.

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Six ways a health book leaks commission

Renewal paid instead of initial

A new-to-Medicare enrollment should pay the initial rate, up to the CMS maximum. Paid as a renewal, you lose roughly half.

Prorated or partial-year pay

Mid-year enrollments and plan changes are prorated — sometimes incorrectly, or never trued up later.

Mixed statements, one rate

ACA, Medicare Advantage and Part D on one statement each pay differently. Every line is priced by its own plan type.

Members moved off your book

A member switches plans with the same carrier and your writing number drops off. The next statement just skips them.

Enrolled members never paid

Active members who appear on no statement are found by matching your book against what the carrier paid.

Old year's CMS amounts

CMS changes the maximum amounts every year and by state. The scanner uses the right year and state group automatically.

Products covered

Medicare, ACA and supplemental health

Medicare Advantage and Part D use built-in CMS amounts by year, state group and new or renewal status. ACA and other products use your own flat fees or percentages — lines without a rate are flagged, never guessed.

Medicare

Medicare Advantage, MAPD, D-SNP, C-SNP, Part D, Medigap Plans G, N and F

Individual & family

ACA marketplace plans (flat per-member fees), off-exchange, short-term medical

Supplemental

Dental, vision, hospital indemnity, cancer, critical illness, accident, short-term disability

How an audit runs

  1. 1. Add the carrier. Medicare amounts are already built in; add your ACA flat fees or supplemental percentages.
  2. 2. Bring in your book. Member, plan, effective date and whether it's new or renewal.
  3. 3. Drop in the statement. Spreadsheet, CSV or carrier PDF — mixed ACA and Medicare lines are fine.
  4. 4. Read the findings. Short-paid, never paid, renewal-instead-of-initial and missing members, with the math shown.
  5. 5. Send the dispute. A letter quoting the member, plan, the correct CMS or contracted amount and the shortfall.

Guides

Medicare, ACA and health statement guides

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