1095-B Monthly Coverage Review Workbook

Begin with a reconciled provider-scoped person key, reporting year and statement relationship. Use the covered-person reconciliation to resolve identity ambiguity before deriving coverage months. A correct interval attached to the wrong person still produces incorrect reporting.

Collect the relevant enrollment, termination, reinstatement and correction events. Preserve effective dates separately from event-entry and extraction timestamps. Record which events remain operative and which have been superseded by an approved source correction.

Confirm the arrangement is in the reviewed B-series reporting scope. The 2025 instructions address covered-person reporting and multiple-plan situations. The workbook assumes that scope determination has been made; it does not decide that every event in a benefits feed belongs on this form.

Document whether the source end date is the last covered day or the first day without coverage. Convert it only through a reviewed mapping. Keep the original value and convention so a boundary dispute can be traced back to the supplying system.

Where two events describe overlapping confirmed coverage from the same relevant source, preserve both event references but evaluate the covered period without double-counting the overlap. Where one event cancels or supersedes another, retain the history and the approval establishing which period governs.

Do not infer coverage solely from a premium transaction, a claim date or a current active flag. Those records can support investigation, but the monthly result needs confirmed coverage facts. Assign unresolved effective periods to the enrollment owner instead of filling a month based on the most convenient available date.

Fictional example: person MC-024 has confirmed 2025 coverage from January 10 through March 31 and again from July 15 through December 31. The provider's convention identifies the last covered day explicitly. No other operative periods exist in the initial source version.

The initial result is 3 + 6 = 9 covered months. January and July count despite partial starts. Under the 2025 Part IV instructions, individual-month indicators apply because the person was not covered in all twelve months.

Store the supporting interval references beside the monthly result. A reviewer should be able to identify why April is unmarked without searching an unrelated current-year enrollment screen.

Continue the fictional case with an approved later source update establishing coverage for April 1 through May 31, 2025. The new interval adds April and May while June remains without confirmed coverage. The updated result is 3 + 2 + 6 = 11 covered months.

The review identifies two changed month cells and preserves the earlier nine-month result as history. It does not replace the reporting year with the year in which the update was processed. The new source version still concerns 2025 coverage.

The B-series correction instructions require corrections for retroactive coverage changes when applicable. If the earlier information was already filed or furnished, hand the original and new facts to the correction intake process. Do not let an updated internal worksheet silently stand in for required follow-up.

For each person, compare the twelve-cell pattern, its count of covered months and the source intervals. Two patterns can contain the same number of months while differing in which months are covered. A count alone cannot detect that substitution.

Check that the all-twelve-months indicator agrees with the reviewed pattern. In the updated MC-024 example, eleven months do not justify an all-year indicator because June remains unmarked. Also check that another covered person in the same statement did not inherit MC-024's gap or update.

At group level, reconcile the number of people reviewed separately from the number of covered person-months. Those totals describe different units. Retain a list of unresolved intervals so an aggregate report cannot hide a person whose month derivation is still awaiting source confirmation.

Save the source snapshot, operative event list, date convention, monthly result and change history together. Record the reviewer and the specific version approved. The worksheet should distinguish an unresolved period from a confirmed absence of coverage under the reviewed source.

Give a colleague the MC-024 case and ask them to reproduce both the nine-month original and eleven-month updated patterns. If the result depends on an undocumented interpretation of an end date, add that missing definition to the data dictionary.

Hand approved person-month data to preparation with the statement relationships intact. Preserve any correction referral and its owner separately. The monthly review establishes source-backed reporting values; file packaging, transmission and actual agency outcomes remain later parts of the workflow.