Resources · Reconciliation & shortfalls

The medical-aid reconciliation checklist

A practical, step-by-step method for reconciling your monthly remittances — what to match, what to flag, and what to query. Written for Zimbabwean practices, whether or not you use MedFi.

Why this matters

Every month, Zimbabwean medical aids underpay, reject and delay claims. The money that stays with the payer is not lost — it is un-queried. This checklist is the minimum a practice needs to do every month to know what it is actually owed, and to get it back.

The method

Pre-reconciliation prep

Before the remittance opens, confirm your submitted claims ledger is complete for the period — every claim, its member number, claim number, treatment date and claimed amount. A remittance cannot be matched against records you have not entered.

Line-by-line matching

Match each remittance line to a claim on member number, claim number and treatment date. Flag any line that does not match cleanly — these are your first queries.

Shortfall identification

For every matched line, compare claimed vs paid. Where they differ, record the reason code on the remittance. The difference is the gap you are owed.

Bank confirmation

A remittance is advice, not money. Confirm the deposit actually reached your account before you close the invoice — and confirm the amount, not just the date.

The monthly checklist

  • Claims ledger for the period is complete and up to date
  • Member numbers, claim numbers and treatment dates are captured for every claim
  • The remittance is matched line-by-line, not in totals
  • Every short-paid line has a reason code recorded
  • Every unmatched line is flagged for query
  • Query letters are drafted and sent before the next remittance arrives
  • No invoice is closed until the deposit is confirmed at the bank
  • Outstanding queries are reviewed each month, not left to age

Common mistakes

Matching totals instead of lines.

A matching total can hide a swapped claim and an underpaid one. Match line-by-line.

Treating a remittance as proof of payment.

A remittance tells you the payer's intention. The bank statement tells you the truth. Confirm before you close.

Letting queries age.

A query you do not send is money you have written off. Query within the month — payers move on.

Not capturing member numbers at the desk.

Reconciliation fails first at reception. The member number and suffix captured wrong is an unmatched line later.

Zimbabwe note. Different aids format remittances differently — CIMAS, PSMAS, First Mutual, Alliance — but the reconciliation logic is the same. If your member numbers are captured cleanly at the front desk, the format of the remittance becomes a parsing problem, not a matching problem.

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