Reconciliation: matching what SHA paid to what you claimed

Submitting a claim is not the same as being paid for it. Reconciliation is where you find out which claims were actually settled, which were short paid, and which have gone quiet.

Role: biller, records and administrator.

Importing a remittance

When SHA sends a remittance, import it as a CSV. The import is safe to repeat: running the same file twice does not double count, so if you are unsure whether an import completed, import it again rather than guessing.

You can also add a payment by hand when a settlement arrives outside the normal remittance file.

How matching works

Matching runs in two passes. First it matches on the payment reference, which is the reliable case. Whatever is left over is then allocated against the oldest unsettled claims first, which is how a batch payment with no line detail is normally reconciled.

Matching is an overlay. It records what it believes was paid against what, and it never edits the underlying claim. If the match is wrong, the claim is still intact and you can correct the allocation.

What the numbers mean

The reconciliation view shows the match rate and the amount still outstanding. Receivables shows the same money by age, in the usual buckets, so you can see whether the outstanding balance is one recent batch or a long tail nobody has chased.

What this does not do

There is no bank statement import, and that is deliberate. Reconciling to a bank feed means holding banking credentials for the clinic, and the remittance is already the authoritative statement of what the payer decided. Money that arrived in the bank without a matching remittance is a question for the payer, not a matching problem.

See also Billing for assembling and submitting the claim.