| Bill month | Should bill (EE) | Carrier billed (EE+SP) | Overcharge | Cumulative |
|---|---|---|---|---|
| June | $320.09 | $687.59 | $367.50 | $367.50 |
| July | $320.09 | $687.59 | $367.50 | $735.00 |
| August | $320.09 | $687.59 | $367.50 | $1,102.50 |
TareSum is a monthly carrier bill audit for TPAs and brokers. We recompute every line of the bill from your enrollment data and the contract rates, and hand back the exceptions in dollars: who, which plan, which months, and exactly what the carrier owes back.
No system to install. No workflow change. A BAA before any file moves.
Nobody re-derives a list bill line by line. The bill gets a totals-level sanity check, the total looks plausible, and it gets paid. That process has three structural blind spots — and each one gets more expensive with time.
A tier change the carrier never applied doesn't overcharge you once — it overcharges you again next month, and the month after. A single missed change routinely rides three to six bills before anyone notices, because nothing in the normal workflow ever recomputes the line.
Carrier contracts cap retroactive premium credits — commonly 60 or 90 days, sometimes two billing cycles. An overcharge caught in month one is fully recoverable. The same overcharge caught in month four is partly a permanent loss. The audit isn't just about finding errors; it's about finding them inside the window.
One month's bill can carry retroactive corrections from six prior billing periods — credit/rebill pairs, partial adjustments, adjustments to adjustments. The section that's supposed to show corrections becomes the noise that hides the errors. Analysts skim it because reading it properly takes hours.
A real pattern from the sample audit: an employee drops spousal coverage effective May 1. The change is entered on time. The carrier keeps billing the old tier.
| Bill month | Should bill (EE) | Carrier billed (EE+SP) | Overcharge | Cumulative |
|---|---|---|---|---|
| June | $320.09 | $687.59 | $367.50 | $367.50 |
| July | $320.09 | $687.59 | $367.50 | $735.00 |
| August | $320.09 | $687.59 | $367.50 | $1,102.50 |
Each individual month is 0.3% of this group's bill — invisible at the totals level. By August it's a four-figure recovery, and if the contract has a 90-day retro cap, June is already at the edge of the window. The full breakdown, including what happens when a partial credit has already been applied →
Written for the people who actually work these bills. Each one is a worked example — real math, line by line — from the same synthetic group as the sample audit, so you can check our arithmetic.
Missed changes compound monthly, retro caps turn late catches into permanent losses, and the three-amount reconciliation that trips up every spreadsheet.
Why "we sent the term file" isn't proof of anything, the cycle-cutoff trap, and how COBRA re-adds teach analysts to ignore exactly the wrong lines.
Per-$100 vs. per-$1,000 rate bases, salary rounding, guarantee-issue caps — and why a 900% overcharge hides in plain sight next to a family medical premium.
Full month, daily proration, the 15th rule, first-of-following — all defensible, only one in your contract. The error is applying the wrong right answer.
Credit/rebill pairs that cancel to zero, pairs that don't — and how a "small net" adjustment section conceals real overcharges behind unrelated credits.
An under-charge feels like a win until the lump-sum back-bill arrives — or until a claim comes in for someone the carrier never enrolled.
A sample audit of one group — three months of bills checked against the enrollment record. Synthetic data, real math. 616 lines in, 13 exceptions out, every one drillable to the per-month arithmetic.
Your enrollment extracts (any export format) and your last three months of carrier bills — three, because terminations, retro changes, and rate drift only prove out across bills, and 90 days is the recovery window most contracts allow. After the first cycle, each month's audit needs only that month's files. We take them however you already move files — your SFTP, ours, or a secure upload link. Never email.
Tier by tier, effective date by effective date — including proration rules, volume-rated coverage, and retroactive changes against prior periods.
An audit report and a working exception workbook: who, what plan, which months, the exact dollar variance, and the evidence for the carrier dispute.
You already have enrollment systems and carrier feeds. What's missing is the check between them — someone recomputing what the bill should say before it's paid, every month, while recovery is still possible.
Everything you run today stays exactly where it is. There's nothing to implement, nothing to integrate, and nobody's workflow changes — the audit sits beside your process, not in it. If you ever stopped sending files, you'd simply stop getting audits; nothing else about your operation would notice.
TareSum is delivered monthly, priced per group, and cancelable any month. The first cycle is the proof: if we don't find anything worth the fee, that's a clean bill — and worth knowing.
Census files and carrier bills contain protected health information. The transfer is designed around that fact — and around whatever file-movement tooling you already trust.
We execute a business associate agreement before the first byte moves. No exploratory "just send us a sample" with real member data — ever. If you want to test the process first, we'll run it on a synthetic file.
Our standard BAA covers the terms your compliance team will look for: use of PHI limited strictly to performing the audit, no secondary use or disclosure, breach notification without unreasonable delay, subcontractor flow-down (our infrastructure runs on Microsoft Azure under Microsoft's HIPAA BAA), and return or destruction of your data when the engagement ends. If your organization has its own BAA form — most do — we'll sign yours instead. We don't make that a negotiation.
Use the SFTP tooling your team already runs for carrier files, drop files on ours, or use a per-client secure upload link. If you have an existing secure share you control, we'll pull from it. The one thing we never do is accept PHI by email.
Files are encrypted at rest, access is limited to the analysts on your audit, and source files are purged on a schedule you set after each audit is delivered. Your data exists with us to be audited, not accumulated.
One group, three months of bills, your enrollment files. Three months because that's the retro window — the errors worth money live across bills, and the clock to recover them is already running. We'll return the audit and walk you through every exception we found.
taresum@resoluteconcepts.com