Be Cautious if Ignoring Absence Management Discrepancies

This post is brought to you by Optis’ Business Analyst, David Spring.

Have you ever experienced a situation in which your HRIS system indicated an employee was being paid for a disability but you weren’t sure that his or her disability was approved by your third party administrator (TPA)? Most of us have probably all been there at some point and had that uneasy feeling that something isn’t right. Having this notion is uncomfortable and unsettling, and, with the right tools in place, anyone in benefits and compensation should readily be able to resolve. An organization making an attempt to successfully ‘sail’ through the waters of integrated disability management (IDM) should easily be able to answer these types of absence management discrepancies with integrated data from both systems. But how do you start?

First, you need to determine a way to integrate the data from your HRIS system and the TPA’s system(s). This is typically done by a company that specializes and provides business intelligence services related to benefits and compensation. This type of partner will have the ability to create methodologies which are able to associate records from multiple systems in order to link common records. Unfortunately, it’s not usually as simple as matching records from both systems because both systems don’t typically use a common identifier. Other routines must be utilized to successfully combine information from both the HRIS and any TPA system (disability, workers’ compensation, FML, etc.) and assess any discrepancies.

Secondly, a framework needs to be developed for what type of discrepancies will be identified and assessed. The types of discrepancies may be driven by existing suspicions or assumed problems, but it’s best to let the data drive the types of discrepancies. Data will often indicate three types of discrepancies:

  • Absences in HRIS not in the TPA’s system
  • Absences in the TPA’s system not in HRIS
  • Absences in both systems but with differing data

Each of these inconsistencies is symptomatic of a different type of problem. What type of problem, you ask? An absence in HRIS but not in the TPA’s system may be indicative of a misstep on the part of the employee to contact the TPA informing them of his/her absence. So, it’s potentially a telltale sign, and potentially an epidemic depending on the volume of a breakdown in the expected behaviors of employees who are going out on leave. An absence in the TPA’s system but not in the HRIS system is suggestive of a different type of HR-related glitch or snag. This problem is more likely company-driven resulting from a breakdown between employee managers and HR of the process to report and record employee absences.

Absences in both systems but with differing data can result from a variety of reasons and are connected with either system. It may be that the disability start and end dates associated with the absence are different. Why is this significant? If the end date in the HRIS system is three days longer than in the TPA’s system and the HRIS data is the primary system of record for check-cutting, than the employee is potentially overpaid. If this type of overpayment is frequently repeated, then it needs to be detected and resolved. Other types of discrepancies in this third category can be related to differences in claim status, differences in the amount of FML time taken or differences in the type of injury reported for workers’ compensation etc. The possibilities and ramifications related to discrepancies can easily begin to grow exponentially, leaving you with a mess to sort through.

Without an integrated IDM approach, discrepancies will continue, excessive absences will be unabated and losses can occur. Start today by taking the necessary steps to ensuring your HRIS system and TPA carrier are on the same page.