Reconciling EDI Data

If you are working with a Certified Broker Partner, please work with them to make any updates you need to reconcile your EDI file feed.  Otherwise, if you are using your own broker, you will need to make these updates or work with your broker to update Zenefits.

Groups who utilize EDI on Zenefits may receive reports from the insurance carriers that require your attention.  Below are some common reasons why the insurance carrier may need your help in order to correct or clarify enrollment information and how to resolve the issue:

1. Member/Dependent Dropped or Added

  • When a member is terminated from the company or when an employee removes a dependent from coverage, Zenefits sends the date this occurred via the EDI file.  However, sometimes the carrier still double checks this information, especially if there are many affected employees, to ensure this was not an error
  • This type of request will also be made when enrollments are changed with the insurance carrier directly and not with Zenefits.  To avoid this, make sure you and your employees are always making changes directly in Zenefits
  • To verify the enrollment event date in Zenefits, follow the steps on this page and respond to the carrier with the applicable information.  
2. Demographic Mismatch
  • This occurs when there is conflicting information between Zenefits and the insurance carrier, such as SSN or DOB.  This can happen if information was changed directly with the carrier and not Zenefits or if an employee is waiting for a SSN to be issued and entered a placeholder in the meantime
  • If the data in Zenefits is correct, then you will need to indicate on the carrier report that their records should be changed.  If the carrier is correct, the data in Zenefits must be updated - any sensitive information will need to be updated by the employee.  Instructions to update dependent details can be found here, while employee details can be found here
3. Effective Date Mismatch
  • There are several reasons why an effective date for a line of coverage may not coincide with what the insurance carrier has on file, some of which may be: the waiting period in Zenefits differs from the carrier's, a member enrolled outside of a normal enrollment window without a valid Qualifying Life Event, or the carrier just needs to confirm a QLE  event date
  • To verify the effective date sent by Zenefits, look up the information here.  If you need assistance updating the group settings in Zenefits, please reach out to your broker or, if needed, to Customer Care via the Support app on your Zenefits dashboard
4. Coverage Tier/Plan Mismatch
  • If the carrier has an employee enrolled in a different plan or categorized in a different division code than what is listed in Zenefits, it will be flagged as an error.  This typically happens if changes were made with the carrier directly and not in Zenefits
  • If the data in Zenefits is correct, then you will need to indicate on the carrier report that their records should be changed.  If the carrier is correct, the data in Zenefits can be updated by following the steps here
Other Things to Know
  • If you would like to change the person at your company who receives these emails from the carrier, simply let the carrier know and they will update their system.
  • If you have questions about how to read or update the information in Zenefits, you can reach out to our Customer Care team by clicking on the Support app in your Zenefits dashboard.  
  • If you have questions about how your group benefits are set up with the carrier, please reach out to your insurance broker.
  • If you have questions on the information contained in the report or need clarification on what is being asked, please reach out to the insurance carrier

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