Verifying Data Now Bypasses Costly Plan Year Crises
HR professionals have seen it all when managing the monthly premium billing administration of a group’s employee benefits: the incorrect rates, the swapped plans, the missing dependents, etc. So many pieces of information need to synchronize to deliver a positive benefits experience to employees. When the plan year runs smoothly, groups are more likely to renew, so now is the time to encourage them to verify their enrollment data. If eligibility and enrollment files are not validated, the new plan year begins with compounded mistakes, premium leakage, and crisis management.
The Financial Reality of Dirty Data
AdminaHealth has implemented the Billing Suite® across diverse industries and consistently finds the same pattern: employers assume their data is accurate until a crisis arises and a forced reconciliation proves otherwise. For example:
- Upon a mid-plan year implementation, it was discovered that a large medical device manufacturing company with over 4,000 employees had been unknowingly overpaying their LTD premiums for months due to an incorrectly applied coverage cap on their base plan. They had overpaid $213,000 at the time of discovery. Had it not been found, it would have cost the company over $500,000 by year-end. An early audit would have prevented this.
- A healthcare services group with 837 employees implemented the Billing Suite mid-year. Due to non-validated data, they discovered billing errors for 115 employees who terminated or waived coverage, totaling $56,871.
- During implementation for an engineering firm with just under a thousand employees, AdminaHealth discovered the “buy up” and “base” premiums had been switched. They were being charged correctly in the enrollment system, but the carrier data was not updated. Had this not been caught, it would have cost the company $420,000 in overpayments for the year.
This is not rare. It is common. And it is avoidable.
Why It Happens
There are many reasons enrollment data is not as pristine as HR would like to believe, including;
- Multiple systems of record create drift between HRIS, payroll, and carrier systems.
- Manual processes—spreadsheets, email files, late updates—introduce errors.
- Life events and terminations are not consistently updated across carriers.
- HR bandwidth is insufficient for continuous reconciliation.
Without a systemized protocol of checks and balances, errors accumulate silently until invoices reveal the cost. When companies start exceeding their benefits budgets, groups ask their brokers for premium billing solutions, not realizing that they could have bypassed the time and financial drain if they had implemented an ongoing audit solution.
How AdminaHealth Solves the Problem
The AdminaHealth Billing Suite® integrates feeds from HRIS, payroll, and carriers. It normalizes eligibility data, applies validation rules, flags exceptions, and consolidates bills into auditable payment files, and can even send payments. Clients transition from reactive spreadsheets to proactive, exception-driven control with documented evidence for every change.
The ROI Is Direct
A simple calculation makes the case:
Groups can calculate an estimated savings using AdminaHealth’s ROI Estimator.
Common Objections Answered
HR and Finance often skip putting checks and balances in place around their premium spend due to the following reasons:
- “We trust carrier invoices.”
Carrier bills reflect what they were told. They do not validate your terminations or waivers. - “We lack IT resources.”
The Billing Suite leverages standard data feeds. Implementation requires data validation, not custom code. - “Our broker audits this.”
Broker audits are valuable but episodic. Automated reconciliation every month prevents drift between audits. No more expensive surprises.
Why Now is an Excellent Time to Implement
Q4 is an ideal time for groups to establish control over their data before open enrollment magnifies every error. Implementing an automated premium billing solution will help them quickly identify mistakes and missing information and start the plan year off prepared, not panicked.