> ## Documentation Index
> Fetch the complete documentation index at: https://docs.sigmahmis.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Reconcile Insurer Remittances and Payments in Sigma HMIS
> Match insurer remittance advice and patient payments to open claims in Sigma Health HMIS, closing the revenue trail from visit to cash.
Payment reconciliation is the final step in the revenue trail — linking what the insurer paid to the claims it covers, and surfacing anything that was short-paid or missed. Completing this step in Sigma closes the loop on each claim and keeps your outstanding balance reports accurate.
## Before You Start
Have the following ready before you open Sigma to reconcile a remittance:
* **Insurer remittance advice (EOB)** — The document from the insurer listing each claim paid, approved amounts, adjustments, and denials
* **Payment date and total amount received** — As shown on the remittance or your bank statement
* **Bank deposit reference** — The reference number from your bank confirming the deposit, for cross-referencing
If your remittance advice does not match the bank deposit amount, resolve the discrepancy with your finance team before posting in Sigma. Posting an incorrect total creates an imbalance that is harder to correct after the fact.
Open the **Payments** module from the main navigation. The Payments module shows your list of posted and pending remittances, along with any unmatched payment lines requiring attention.
Click **New Remittance**. Enter the following details in the remittance header:
* **Insurer / Scheme** — Select the scheme this payment came from
* **Remittance date** — The date shown on the remittance advice
* **Total amount received** — The total payment amount from the insurer
Save the header. Sigma creates a remittance record and opens the line-entry view.
For each line on the remittance advice, add a corresponding line in Sigma. Enter:
* **Claim reference** — The claim number as it appears on the remittance advice
* **Approved amount** — The amount the insurer approved for this claim
* **Adjustments** — Any deductions applied (e.g., co-pay recovery, benefit limit reduction)
* **Denial code** — If a line was denied, enter the denial code and reason
Work through every line on the remittance advice before moving to matching. A complete line list makes the matching step faster and prevents unmatched balances.
Click **Match Claims**. Sigma automatically suggests matching open claims for each remittance line based on claim reference number, patient details, and visit date.
For each suggestion:
* Review the matched claim to confirm it is the correct one
* Click **Confirm Match** to link the remittance line to the claim
* If the suggested match is wrong, click **Change Match** and search manually for the correct claim
Continue until every remittance line with a valid claim reference has a confirmed match.
When the approved amount on a remittance line differs from the amount on the matched claim, Sigma flags a **variance**. For each variance, record the reason:
* **Co-pay adjustment** — The insurer deducted the patient's co-payment from the scheme payment
* **Benefit limit reached** — The approved amount is capped by the patient's annual benefit
* **Service not covered** — A line item was excluded from the scheme's benefit schedule
* **Rate difference** — The insurer applied a different tariff than the one billed
Documenting the variance reason keeps your revenue reports accurate and gives you evidence if you need to dispute the adjustment later.
Once all lines are matched and variances are recorded, click **Post Remittance**. Sigma:
* Updates each matched claim to **Paid** status
* Posts the approved amounts to the claims' payment history
* Recalculates outstanding balances for each scheme and patient
* Adds the remittance to the revenue summary for the period
Posted remittances cannot be edited. If you discover an error after posting, use the **Remittance Adjustment** function to create a correction record.
## Unmatched Lines
If a remittance line does not match any open claim in Sigma, do not skip it. Work through the following checks before escalating:
1. **Check the claim reference** — Confirm the reference number on the remittance advice matches what was submitted. Transcription errors are common.
2. **Search by patient and date** — Use the claim search to find the claim by patient name and visit date if the reference number doesn't match.
3. **Verify the claim was submitted** — Check the Claims queue to confirm the claim exists and has a Submitted status. If it was never submitted, create and submit it now.
4. **Escalate to the insurer** — If the claim was submitted and the reference is correct but Sigma still can't locate a match, contact the insurer with your submission records to confirm they received it.
Leave unmatched lines in the remittance record as **Unmatched** until resolved. Do not delete them — they represent money received that must be attributed to a claim.
## Patient Co-payment Reconciliation
To record a patient direct payment against an outstanding invoice balance:
1. Navigate to **Billing** and open the patient's invoice.
2. Click the **Payments** tab on the invoice.
3. Click **Record Payment** and enter:
* Amount received
* Payment date
* Payment method (cash, card, mobile money, cheque, or other)
4. Click **Confirm**. The patient balance on the invoice updates immediately, and the payment appears in the invoice payment history.
Patient payments recorded this way are included in the **Payments Received** total in your revenue summary view.
Reconcile remittances within 3 business days of receipt. The longer you wait, the harder it is to identify which claims are still genuinely outstanding versus already paid — and your aging reports become less reliable as a collection tool.
## Related
Configure payment methods, manage remittance records, and view payment history.
Monitor billed amounts, outstanding balances, and collection trends in real time.
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