Hca.wa.gov Insurance Accounting Training
www.hca.wa.govInsuranceAccountingTrainingState (Central Pay)AgenciesUpdated November 20207
INSURANCE ACCOUNTING TRAININGFOR STATE (CENTRAL PAY) AGENCIESINVOICING . 1PAYMENTS . 1STATE SHARE TRANSFER PROCESS . 2PAYROLL AND THE STATE SHARE PROCESS . 3STATE SHARE TRANSFER PROCESS CALENDAR FOR 2020 . 4SYSTEM LIMITATIONS . 5OPTIONAL LTD ACCOUNTING . 62021 MEDICAL/DENTAL PLAN CODES . ERROR! BOOKMARK NOT DEFINED.HEALTH CARE AUTHORITY REPORTS FORMAT . 11SAMPLE MDR . 12USING THE “DAILY ELIGIBILITY UPDATE REPORT” . 13AND “DAILY ADJUSTMENT REPORT” . 13DAILY ELIGIBILITY UPDATE REPORT . 14MONTHLY ELIGIBILITY UPDATE REPORT . 16USING THE MONTHLY “ELIGIBILITY UPDATE” AND “ADJUSTMENT” REPORTS . 16DAILY ADJUSTMENT REPORT . 17DAILY TRANSFER HOLD FORWARDING REPORT . 20MONTHLY TRANSFER HOLD FORWARDING REPORT . 22RECONCILIATION NOTES. 23BASIC RECONCILIATION FORMULA . 23TO SIGN UP FOR FUZE . ERROR! BOOKMARK NOT DEFINED.7
INVOICINGInvoicing is created in one of three ways: Monthly: monthly invoicing is an automated process that runs after the 25 th payroll and isfor the following month. It runs on “cycle 3”, which is the last weekday of the month,excluding holidays. Invoicing is for coverage for the following month (for example,invoicing created on 01/29/21 will be for February 2021 coverage).Daily: when an agency enters an eligibility change after monthly invoicing has alreadyprocessed for the month, a daily “invoice” is created. For example, if an agency retroenrolls a subscriber on 03/26/21 with an effective date of 01/01/21, the daily processwould recognize that January 2021, February 2021 and March 2021 invoicing had alreadyrun and would post ALL 3 invoices as part of the daily process. These invoices would bepart of the April 2021 state share transfer.Manual: manual invoicing occurs when an agency requests an adjustment (usually viaFUZE) because they cannot key the correct effective date for an eligibility change online.In most cases this would be due to the effective date of the change being beyond thelower limit date, the effective date of the change being prior to an existing effective datealready on the account, or to correct a keying error. PEB Customer Service staff willenter/correct the eligibility information and PEB Accounting staff will manually postadjustments to the affected invoices.PAYMENTSPayments for insurance premiums are made in one of two ways: State Share Process: this is the automated monthly process by which the state payrollsystem transfers insurance premiums from your 035 agency revolving fund to Health CareAuthority (HCA).Manual Journal Vouchers: these are very rarely needed, but Journal Vouchers can beused to transfer premiums outside the automated processes. Journal Vouchers for LTD oremployer health premiums need to be pre-approved by HCA before your agency keysits side or sends a Journal Voucher to the Office of the State Treasurer (OST) pleasesend it to HCA for approval. Once the journal voucher is approved, we will send theoriginal to the OST and send a copy back to you.1
State Share Transfer Process The state share transfer process is an automated process that transfers the amountinvoiced for insurance coverage from your agency to HCA. This process runs once a month, around the 23rd, and after the payroll has run for the 25thpayroll. See the enclosed calendar for 2021 state share transfer process dates, or checkthe PAY1 system for the on-line calendar. The transfer includes the employer share, the employee contribution, and any applicablesurcharges. The contributions are put into your 035 agency revolving fund and transferredto HCA on the State Share date. Employee contributions are deducted from the payrollson the 10th and the 25th of each month for the current month’s premium (not lagged likeoptional premiums). The state share transfer process is composed of all invoicing transactions that postedsince the prior state share transfer process ran. The transfer includes the entire amountowed, regardless of the amount actually deducted from the employee’s payroll. Example:March’s state share process includes all transactions dated from February 24th throughthe night of March 23rd. Discrepancies between payroll deductions for the employee contribution and surchargesand the amount transferred on state share are reported via the A.23 screen on a monthlybasis.7
Payroll and the State Share Process(Payroll)(Payroll)(HCA)(HCA)(State Agency)(Agency)7
State Share Transfer Process Calendar for2021Do not key eligibility changes the day before and the day of the StateShare Transfer 237
System Limitations DO NOT key any eligibility changes that may affect premiums on the day stateshare runs. The changes you key will not fully process before the state share processruns and may cause reconciliation problems for your agency, HCA, and/or the insurancecarriers. Anything not keyed prior to the day before state share runs must be heldfor two business days and not keyed until the day after state share run. See “2021State Share Keying Instructions” on the PERSPAY website. Keying two different effective dates for any changes on same day. If you have twodifferent effective dates for changes such as medical that is effective one date andtobacco attestation that is effective another date, key each change on separate days,letting the system update overnight for each change. Keying an enrollment and a termination on the same employee or dependent on thesame day causes invoicing problems. If you make an error when keying a change, letthe system process the change overnight, and then key the correction the next day. One month of invoicing may not get backed out. If an employee or dependent isenrolled in error and then terminated effective same date as the enrollment effective date,the insurance system assumes that they were enrolled for one month and will not backout the first month’s invoice. Contact HCA Accounting when this occurs and we willmanually adjust the invoicing. Keying multiple SSN changes on the same employee or dependent on the same daywill cause invoicing problems. If you change the SSN of an employee or dependentand make a keying error, wait until the next day before keying the correction. IF youdiscover that an incorrect SSN was entered in the past, example: Employee hired01/01/17, in November you uncover the error, DO NOT correct the SSN, contact PEBAccounting via FUZE for assistance. Keying eligibility screens out of numeric order can cause problems. Newenrollments (new hires) and multiple changes (like marriage) should be keyed in the orderof the screen numbers (i.e.; A.41, A.43, A.44, etc). If the numeric order is scrambled (i.e.;keying the A.45, then the A.44, then the A.43,) the invoicing process may not read thedata correctly.7
Optional LTD Accounting Optional LTD premium deductions for the current month are taken on the 25thpayroll of the current month and the 10th payroll of the following month and matchthe pay period for the pay date (example: premiums for January 2020 are taken on01/25/10 and 02/10/21). Optional premiums taken by payroll deduction are automatically transferred to HCAby the payroll system each payroll. (not monthly like state share). Premiums collected manually (due to LWOP, FMLA etc.) can be transferred to HCAby Journal Voucher. (see form and instructions) If the employee writes a personal check: Checks should be made payable to the“Health Care Authority” and sent to HCA with a completed “Optional Life and LTDPayment Form” detailing the reason for the payment. If the agency is paying the LTD premiums (usually due to the employee makingthe check payable to the agency instead of HCA): Submit payment to HCA via JV(do not send the JV directly to the treasurer). You should also include the paymentdetails on the JV in the “agency use” and/or “explanation of entry” boxes. Only itemsnot deducted from payroll should be transferred this way. HCA will approve the JV andsend it to the State Treasurer. We will also send a copy back to you. HRMS calculates retroactivity for Optional LTD: If back premiums need to bededucted from an employee’s pay due to retroactive enrollment of Optional coverage,the payroll system will automatically calculate the amount that should be deducted. Ifan employee is receiving pay, the payment does not need to be made outside thesystem. The same is true for refunds that are due to employees due to terminatedcoverage or waivers.7
Using the Optional LTD Payment FormThe Optional Life/LTD Payment Form is used by State agencies when paying an employee’soptional LTD premiums by check or JV. This form must be sent to Health Care Authority withthe payment in order to give HCA the information needed to post the optional payment(s)properly. The fields of the form should be filled out with the following information:1. Agency/Sub-Agency: Enter your agency and sub-agency number.2. Agency Name: Enter your agency name.3. Date: Enter the current date in MM/DD/YY format.4. Employee Name: Enter the name of the employee for which payment is being sent.5. Employee SSN: Enter the social security number of the employee for which payment isbeing sent.6. Coverage Period: Enter the coverage month(s) for which payment is being sent.7. Coverage Type: Enter the name of the type of premium(s) being sent “LTD”.8. Explanation: Enter a brief explanation of why the payment is being sent (employee onLWOP, etc.).9. Prepared By: Enter the name of the person preparing the form (please print for easyidentification if an HCA staff must call with questions).10. Phone Number: Enter the phone number of the person preparing the form (include areacode if outside local calling area of Olympia).Send form with payment to:Health Care AuthorityAttn: PEB AccountingPO Box 42691Olympia, WA 98504-2694Remember to list each coverage period, coverage type, and premium amount being remitted.If the payment covers more than one coverage month and/or coverage type, each month andtype must be listed separately on the form for proper processing. Contact PEB Accountingstaff if you have any questions about completing the form correctly.7
Optional LTD Payment FormAgency/Sub Agency:EMPLOYEE NAME (Last, First)Agency Name:Date:COVERAGE PERIOD(mm/yyyy)EMPLOYEE SSNCOVERAGE TYPE(LIFE OR LTD)PREMIUMAMOUNTPrepared By Phone NumberPlease keep a copy for your files. Send the original with the original payment JV or check to HCA, PO Box 42691, Olympia, WA 98504-2691.8
Health CareAuthorityReports &Forms9
2021 Medical/Dental Carrier CodesMEDICAL PLAN CODESPLANCODEWELLNESS CODEPLAN NAMECURRENT PLANSCCWKaiser WA ClassicC1C1WKaiser WA Sound ChoiceCVCVWKaiser WA ValueCHSACHSWKaiser WA CDHPDDWKaiser PermanenteClassicDHSADHSWKaiser PermanenteConsumer Directed Health Plan (CDHP)MBUnited Health CarePEBB BalanceMCUnited Health CarePEBB CompleteUUWUniform Medical PlanClassicU1U1WUniform Medical PlanUMP Plus UW Medicine ACNU2U2WUniform Medical PlanUMP Plus Puget Sound High ValueNetwork (PSHVN)UHSAUHSWUniform Medical PlanConsumer Directed Health Plan (CDHP)USUSWUniform Medical PlanUMP SelectZNo Plan SelectedDENTAL PLAN CODESCODEPLAN NAMECURRENT PLANS1Uniform Dental Plan3Willamette Dental Plan 20084DeltaCare9No Plan SelectedPlan code 8 is for LifePlan code 6 is for LTD10
HEALTH CARE AUTHORITY REPORTSFORMATYour AGY/AGY-SUB is in the top left corner.Employees are listed alphabetically by last name in the NAME column.Next is the employee’s SSNBATCH NUMBER AND SEQUENCE# are assigned by the system and show the source of theadjustmentDLY - Daily eligibility updates - system generatedADJ - Adjustments made by Health Care Authority Accounting StaffINV - Invoicing - system generatedXFE - Transfers - system generatedCOV PER indicates the coverage period which is affectedThe TRAN DATE is the date the transaction occurred and is the same as the run date for dailyreports.AGY/SUB-AGY is listed for the adjustmentThe ACCTS REC shows the ER - which includes both the employer portion and the employee healthportion.11
SAMPLE MDR(Miscellaneous Deduction Register)FORM A5-1STATE OF WASHINGTONPAGEDEPARTMENT OF PERSONNEL107MISCELLANEOUS DEDUCTION REGISTER1PAYROLL DATE: SEP 23, 2021 CYCLE: 1W.R. AGENCY NAMEAGY SUB AGENCY NAMESUB AGYINS411 HEALTH CARE AUTHORITY 107 HEALTH CARE AUTHORITYPAYEE NAMESTATE TREASURERDEDUCTION DEDUCTIONCODETITLE0708MD/DNT INSSSNPERNREMPLOYEE 432109ANDERSON, FREDJAMES, SHARONJOHNSON, WILLIAMSANDERS, AMYSMITH, JAMESZANE, MARYZANE, MARYZANE, MARYDEDUCTION TOTALTAXED TOTALEMPLOYEE TOBACCOSPOUSAL EMPLOYERSHARESURCHARGE SURCHARGESHARE TOTAL 4.00
Using the “Daily Eligibility Update Report”and “Daily Adjustment Report” These reports are produced nightly out of the daily invoicing process based on eligibility updatesand manual adjustments that have been keyed throughout each day. In order to verify that accurate accounting adjustments were made, the following fields of thereport should be checked when an account appears on the report: Employee Name and SSN – verify you have keyed or requested updates for all employeeslisted (not all changes will show, employees will only show if the eligibility changes resulted inpremium changes). If you keyed changes on additional employees that don’t show up, but youthink the changes affected the premium, contact HCA via FUZE (secure information, ie. SSN). Coverage Period – is in YYMM format. Verify you have received accounting changes for eachmonth. Agency/Sub-Agency – verify that only invoices/credits for your employees have beeninvoiced and/or credited and the correct sub-agency was keyed. Amount - A negative sign (“-“) after a dollar amount indicates a credit to your agency. Nonegative sign indicates a charge to your agency. Carrier Premiums (Health and Dental) – verify the health and/or dental carrier codes areaccurate. The amounts listed are what will be paid to the carrier and do not directly relate tothe amount the agency or employee pays. HCA pays carriers based on what is entered intoPAY1. Med EC – verify that the appropriate carrier code and corresponding employee contributionhas been properly credited and/or invoiced. (Although this detail falls under “CarrierPremiums”, it represents the amount that will be sent to payroll as “Employee Contributions”). Accts Rec - ER – verify that your agency is being credited and/or billed the appropriateemployer amount(s). This amount listed is the combined total of the employer contribution( 939.00) plus the employee contributions. If you identify any discrepancies or expected different charges, please contact HCA accounting viaFUZE for a review of the transactions. The net result of these daily eligibility updates will process during the next State Share cycle andwill be transferred to HCA. You will see a line for each invoice or credit, for each month, for eachemployee on the MDR from state share.13
DAILY ELIGIBILITY UPDATE REPORTREPORT NAME:Daily Eligibility Update Report by AgencyREPORT NUMBER:HRISDB5044-R04DESCRIPTION:Shows daily eligibility updates made by the agency payroll offices, and/orHCA’s eligibility department that resulted in daily premium adjustments.The daily eligibility update report shows invoices and credits for eachaffected coverage period for each employee. Agencies should receivethis report the day after changes affecting premiums have been keyed forthat agency/sub-agency.14
REPORT NO: HRISDB5044-R04STATE OF WASHINGTONHEALTH CARE AUTHORITYDAILY ELIGIBILITY UPDATE REPORT BY AGENCYRUN DATE: 02/04/21PAGE:1AGY/AGY-SUB: 107NAMESSNJONES, BOBBY 111-22-3333---BATCH---NBR SEQ#COVPERYYMMTRAN DATEMM/DD/YYAGY-SUBDLY0204 178151202/04/21107TOTALROBINSON, JOE 334-45-5667DLY0204 005151202/04/21107TOTALSMITH, JOSEPHINE 800-55-1212 DLY0204 050151202/04/21107TOTALAGENCY 107TOTALEMPLOYER TOTALEMPLOYEE (OPTIONAL LIFE AND LTD) TOTAL15AMOUNT TYPE976.00 EMPLOYER BASIC72.00 EMPLOYEE MEDICAL CONTRIBUTION---------1048.00976.00- EMPLOYER BASIC159.00- EMPLOYEE MEDICAL CONTRIBUTION25.00- EMPLOYEE TOBACCO SURCHARGE---------1160.00976.00 EMPLOYER BASIC5189.00 EMPLOYEE MEDICAL CONTRIBUTION25.00 EMPLOYEE TOBACCO SURCHARGE---------1190.00 1078.001078.00.00
MONTHLY ELIGIBILITY UPDATEREPORTREPORT NAME:Monthly Eligibility Update Report by AgencyREPORT NUMBER:HRISDB5044-R14DESCRIPTION:This report is an accumulation of all daily eligibilityupdates keyed on-line throughout the period.SEQUENCE:Agency/Sub-AgencyTIMING:Produced around the 22nd of each month (not produced ifno changes were keyed during the prior month)Using the Monthly “Eligibility Update”and “Adjustment” Reports Monthly Eligibility Update Report: This report is a compilation of all the DailyEligibility Updates that have occurred since the last monthly report, and it can beused in conjunction with your Monthly Adjustment Report to check your monthlystate share MDRs for accuracy. Monthly Adjustment Report: This report is a compilation of the manual accountingadjustments that have occurred since the last monthly report, and it can be used inconjunction with your Monthly Eligibility Update Report to check your monthly stateshare MDRs for accuracy.16
.DAILY ADJUSTMENT REPORTREPORT NAME:Daily Adjus
payroll of the current month and the 10th payroll of the following month and match the pay period for the pay date (example: premiums for January 2020 are taken on 01/25/10 and 02/10/21). Optional premiums taken by payroll deduction are automatically transferred to HCA by the payroll system each payroll. (not monthly like state share).
your health plan and other insurance options by attending one of the SEBB Program benefits fairs. All are from 4 to 7 p.m., except Pasco, which is 3 to 6 . hca.wa.gov/sebb-employee. hca.wa.gov/sebb-employee. sebb.naviabenefits.com. page 8. hca.wa.gov/sebb-oe. 6 Who to contact for help
Prerequisite: Health Care Administration majors only, HCA 502. 6. HCA 515 Advanced Financial Management in Health Care (3) Prerequisite: ACCT 201 or ACCT 500; HCA 502; Health Care Administration majors only. Fourth Quarter‑Summer 7. HCA 535 Quantitative Methods for Health Admin (3) Prerequisites: Health Care Administration majors only, HCA 502 8.
FINANCIAL ACCOUNTING : MEANING, NATURE AND ROLE OF ACCOUNTING STRUCTURE 1.0 Objective 1.1 Introduction 1.2 Origin and Growth of Accounting 1.3 Meaning of Accounting 1.4 Distinction between Book-Keeping and Accounting 1.5 Distinction between Accounting and Accountancy 1.6 Nature of Accounting 1.7 Objectives of Accounting 1.8 Users of Accounting Information 1.9 Branches of Accounting 1.10 Role .
hca.wa.gov/pebb-employee . hca.wa.gov/pebb-rules . 2023 PEBB employee medical monthly premiums. Effective January 1, 2023, for state agency and higher-education employees. . During open enrollment, you can learn more about your health plan and other insurance options by attending one of the PEBB Program benefits fairs. All are from noon to 3 .
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and has access to data relevant to the operation of the Affordable Care Act ("ACA"). HCA analyzed its data in order to provide information about the ACA's practical operation. All methodologies and calculations were reviewed and verified by HCA's Internal Audit department. Hospital data were sourced from HCA's Enterprise Data .
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