This is not a product screenshot. It's the deliverable — the audit we return after receiving three months of files — walked through the way we'd walk your team through it on the review call. The register of all thirteen exceptions is at the bottom; the findings come first, because a list of variances without the reasoning behind them is just another report to file.
What we received
Nothing exotic — the files the client already produces:
- Three months of carrier bills — Meridian's June, July, and August invoices; the August cycle alone runs 616 lines. Three months isn't a bigger sample for its own sake: a single bill can show a charge that looks wrong, but only the prior bills prove what was actually charged, month by month — and that proof is what the carrier dispute stands on. It's also the retro window: findings inside 90 days are still recoverable.
- The census — the employer's enrollment extract: who's active, in which plan, at which tier, effective and termination dates, and salary where coverage is salary-banded.
- The rate exhibit — the contracted rates from the renewal: per-tier medical rates, and $0.18 per $1,000 of volume for Basic Life with a $150,000 guarantee-issue cap.
No integration, no export project, no new fields. If a file has quirks — and every carrier's does — that's our problem to absorb, not yours to fix.
The topline
Two numbers, not one, and the second matters more than it looks. Overbilling costs money; under-billing costs coverage. A member the carrier isn't billing is a member the carrier may not know it insures — and the moment that surfaces is usually a claim. We flag under-billing with the same severity as overbilling, because "we saved $928 by accident" is not a position you want to explain to a carrier holding a large claim.
The findings
1 · Retro change never applied — three months and counting
Carter dropped spousal coverage effective May 1. The census shows EE; Meridian has billed EE+SP ($687.59 instead of $320.09) every month since — $367.50 a month, three months running.
How it was caught
Not by looking at August. The August line alone is a plausible EE+SP charge at a contracted rate — nothing about it is wrong except the member it's attached to. The catch is the join: census tier against billed tier, member by member. That comparison is trivial for one member and impossible by eye across 616 lines.
Why it's urgent
Meridian's contract caps retro adjustments at 90 days. June is already at the edge of the window. Dispute this month and all $1,102.50 comes back; wait one more billing cycle and June converts from recoverable to permanent. The mechanics — including why the credit will arrive tangled in an adjustment section — are in the retro window guide.
2 · Terminated June 30, billed in July and August
Delgado's coverage ended June 30. She appears on the July bill, and again on August's, at $320.09 each.
How it was caught
This is an absence-of-signal error — the hardest kind for a human reviewer. Nobody audits a bill by asking "who's on here that shouldn't be?" because the answer requires holding the entire termination history in your head. The reconciliation asks it mechanically: every billed line must map to an active election covering that month. Delgado's July and August lines map to nothing.
One check before the dispute
We verify this isn't COBRA before flagging it — a COBRA continuant legitimately appears on the bill after termination, at 102%. Delgado has no COBRA election on file, so these two lines are pure overcharge. Full pattern in the termed-still-billed guide.
3 · Two enrolled members missing from the bill entirely
Both have active elections effective August 1. Neither appears anywhere on the August bill. This is the mirror image of finding 2 — and the register shows it in blue, not red, because the money runs the other way.
Why we flag money in the carrier's favor
Because it isn't in the carrier's favor — it's in limbo. If Meridian's eligibility system doesn't have these members, a Kirkland claim in September gets pended or denied while everyone reconstructs what the EDI feed did in July. And when the carrier does find them, the back-premium arrives as a lump on one future bill, blowing up that month's total for reasons no one will remember. Better to force the correction now, on your timeline. The claim-with-no-enrollment scenario is worked through in the missing-from-bill guide.
4 · Mid-month hire billed a full month
Rasmussen's family coverage is effective August 16. The group's contract prorates daily: 16 of 31 days × $864.61 = $446.25. Meridian billed the full $864.61.
How it was caught
The audit doesn't just compare billed against a rate table — it recomputes what the charge should be under the group's specific proration rule. That distinction matters because "full month," "daily proration," "15th rule," and "first of following" all produce different correct answers for the same August 16 hire — from $864.61 down to $0. A checker that doesn't know which rule your contract uses can't tell this error from a correct charge. All four rules, same member, worked side by side in the proration guide.
5 · Two members billed at the wrong tier — same signature as finding 1
Both are EE on the census; both were billed EE+SP. Individually these look like finding 1 without the history. Together they say something different.
The pattern read
Three members now share the identical EE→EE+SP signature (Carter, Callahan, Ostrowski), at the identical $367.50 delta. One is a fluke; three is a process — most likely a tier-mapping defect in the enrollment feed, which means it will manufacture new instances every month until the mapping is fixed. The dispute recovers $735; the pattern note is what stops the leak. A line-item audit that doesn't group by signature hands you the refund and leaves the faucet running.
6 · The same line, twice
An identical member/plan/month line appears twice on the bill. One is real; the second is pure duplicate.
Why totals-level review misses it
$320.09 on a bill this size is under a tenth of a percent — far inside the month-over-month noise from ordinary churn. Duplicates are only visible when lines are keyed and counted, and they're a close cousin of the credit/rebill pairs that clutter adjustment sections. How we separate real corrections from noise — and why the filter has to match on exact offsetting amounts — is in the adjustment-noise guide.
7 · Life premium computed per $100 instead of per $1,000
The contracted Basic Life rate is $0.18 per $1,000 of volume. Jessup's $150,000 of coverage should cost $27.00; she was billed $270.00. Rasmussen: $18.00 contracted, $180.00 billed. Both premiums are exactly 10× correct — the fingerprint of a per-$100 basis applied against a per-$1,000 rate.
Why volume products hide errors
Medical rates are flat per tier — anyone can eyeball them against the rate sheet. Life premium is computed: salary → rounding rule → GI cap → volume → basis → rate. An error in any step yields a dollar figure that looks unremarkable on the page. The only defense is recomputing the whole chain per member, which is exactly what the audit does. The full four-step chain — including the stale-salary and age-band variants of this error — is in the volume-rates guide.
8 · Three members billed at a rate that doesn't exist
All three were billed $695.93 (Palladino: $695.92) against a contracted family rate of $608.17. Here's the detail that tells the story: $695.93 appears nowhere in the rate exhibit — at any tier, any plan. And the third member's penny difference means the rate isn't being looked up at all. It's being calculated — $608.17 × 1.1443, rounding differently per member. That multiplier smells like a proposed renewal increase that was never executed, or last year's rate carried forward with a trend factor.
Why this finding is bigger than $263
An off-book rate means the carrier's billing system disagrees with the contract itself — every member who lands in that rate cell inherits the error, this month and every month forward. The dispute here isn't three line items; it's "show us where $695.93 comes from." That question tends to fix entire rate cells at once.
The exception register
This is the grid your analysts work from — one row per exception, expandable to the month-by-month lines behind it. Click any row. Red variances are money to recover; blue are under-billings to correct.
| Exception | Member | Plan | Months | Expected | Billed | Variance |
|---|
What ships with the audit
The register is the summary. Behind each exception ships the dispute backup: the member's census record, the bill lines cited by page and line, the contracted rate cited to the rate exhibit, and the recomputed correct amount with its arithmetic shown. That package is written so your analyst can paste it into a carrier inquiry without re-deriving anything — the carrier's billing team gets a claim they can verify in minutes, which is the difference between a credit next cycle and a dispute that ages for a quarter.
The review call walks findings in the order above: retro-window items first (they're on a clock), then process patterns (findings 5 and 8, which prevent next month's errors), then the one-offs.