Reconciliation Report is a report generated to get the Pharmacy totals (Deductible and Member OOP Amount) and Medical Totals (Deductible and Member OOP Amount) of each member of a benefit year period. This report provides accumulator totals for a selected date range

This report can be used to get the accum totals of the Members. This helps users to understand where exactly member's accumulator balance is. This can also be shared with TPAs to make sure both the systems are in sync in the Accumulation buckets of all Members. The total in the report is ‘As Of Day Totals’. 

The Report consists of

• Membership level Pharmacy Deductible total

• Membership level Pharmacy Member OOP total

• Membership level Medical Deductible total

• Membership level Medical Member OOP total

Procella System is the source of truth for Pharmacy Accumulations. So any third party who receives this report can correct the pharmacy accumulator on their system if there are any discrepancies found.

If there are any discrepancies with Medical totals, then it has to be checked and fixed in Procella system.

Report Layout

File Format : Tab-Delimited Text file

#	Field Name	Description	Format
1	Medical Cardholder ID	This is the Medical Cardholder ID of the Member (This is different from the Member's cardholder ID)
2	Medical Person Code	This is the Medical Person Code of the Member (This is different from the Member's person code)
3	Benefit Year - Start Date	The supported Benefit year is Apr to Mar. So the Benefit Start date is 04/01/YYYY	MM/DD/YYYY
4	Benefit Year - End Date	The supported Benefit year is Apr to Mar. So the Benefit End date is 03/31/YYYY	MM/DD/YYYY
5	Member Last Name	Member’s Last Name
6	Member First Name	Member’s First Name
7	Member Date of Birth	Member’s Date of Birth	YYYYMMDD
8	Medical Deductible total	Medical Deductible total of the Member in Procella System
9	Medical out of pocket total	Medical OOP total of the Member in Procella System
10	Pharmacy Deductible total on your side	This total is for the period range of the field # 3 and # 4. For eg let's say we are generating the report for Benefit Year 04/01/2023 to 03/31/2024. If the report is generated on (say) 04/28/2023, The total Pharmacy deductible will be for the period 04/01/2023 to 04/28/2023. Note: Date of service of the claims is used and not the claim’s adjudication date
11	Pharmacy Out of Pocket total on your side	Same as mentioned in # 10
12	Date Time field	This would be the file generated date/time. Example 1:  Let's say we are generating report for the Benefit Year 04/01/2023 to 03/31/2024. If I am generating the file in the last week of April(say date - 04/28/2023). Then the value would be 04/28/2023 00:00:00 yes Example 2: Let's say we are generating the report for past Benefit Year 04/01/2022 to 03/31/2023 on 04/12/2023 then this field would be 04/12/2023 00:00:00 Time is the UTC time in the Database	MM/DD/YYYY HH:MM:SS

Refer to this page for How to Run Reconciliation Report - How To Run Ad-hoc Reconciliation Report