Run: ACA 1095-C Coding and Filing SOP

The Benefits Analyst confirms the reporting population by reconciling the employee census file against payroll and benefits enrollment records for the reporting year. Measurable criteria: 0 unreviewed employees and 0 unexplained inclusions or exclusions. Expected outcome: a validated ACA reporting population list. Escalate if any employee cannot be classified or if the population differs from source records.

The Benefits Analyst verifies monthly eligibility and coverage data by reconciling payroll, benefits enrollment, and ACA reporting system records for each month. Measurable criteria: 0 missing hire, termination, leave, or coverage change records. Expected outcome: complete and reconciled monthly source data for ACA coding. Escalate if any month contains unresolved discrepancies.

The ACA Reporting Specialist assigns the line 14 offer-of-coverage code for each month using the approved coding matrix and source evidence. Measurable criteria: 100% of months coded with a documented line 14 value or a documented exception. Expected outcome: line 14 codes that match the coverage offer status for every applicable month. Escalate if the offer status is unclear or unsupported.

The Payroll Specialist assigns the line 15 employee contribution code by confirming the employee-only premium contribution for the lowest-cost minimum value plan for each month. Measurable criteria: 0 months coded from the wrong plan year or coverage tier. Expected outcome: line 15 entries that match the applicable monthly contribution amount or a blank entry when permitted. Escalate if the monthly amount cannot be verified.

The Benefits Compliance Analyst assigns the line 16 safe harbor or other relief code by matching each month to documented facts such as non-assessment periods, affordability safe harbors, or other relief conditions. Measurable criteria: 0 unsupported line 16 codes. Expected outcome: each applicable month has a supported line 16 code or a documented reason for no code. Escalate if supporting documentation is missing or inconsistent.

The ACA Reporting Reviewer reviews monthly code combinations for consistency by checking lines 14, 15, and 16 against the approved coding matrix and source evidence. Measurable criteria: 0 invalid combinations and 0 unresolved ambiguous months. Expected outcome: all monthly code combinations are internally consistent and ready for year-end aggregation. Escalate any mismatch or ambiguous month for second review.

The ACA Reporting Specialist documents deviations and unresolved exceptions in the controlled repository with the reason, source evidence, reviewer name, and resolution date. Measurable criteria: 100% of exceptions logged before filing finalization. Expected outcome: a complete exception log that supports audit review and follow-up. Escalate any unresolved exception that could affect filing accuracy.

The Filing Specialist prepares the draft Forms 1094-C and 1095-C filing file by aligning employer-level data, employee-level records, and transmittal information before generation. Measurable criteria: 0 missing required records and 0 known data mismatches at draft creation. Expected outcome: a complete draft filing file ready for review. Escalate if any source data is incomplete or inconsistent.

The QA Reviewer performs a quality review of the draft filing by checking for missing records, duplicate records, incorrect Social Security number masking in internal copies, incorrect employer identification data, and mismatched monthly codes. Measurable criteria: 0 unresolved critical defects. Expected outcome: the draft filing passes internal quality checks or all defects are documented for correction. Escalate any material defect immediately.

The Filing Lead escalates material errors before submission by routing the filing to correction when any material error, missing record, or unsupported code is identified, or to approval when the filing is accurate and complete. Measurable criteria: 100% of filings routed to the correct next step based on error assessment. Expected outcome: a clear decision to correct or approve the filing. Escalate immediately if the error assessment is uncertain.

The Filing Specialist corrects the filing and re-runs validation by fixing the source record or coding logic and then revalidating the file. Measurable criteria: 0 unresolved material errors after revalidation. Expected outcome: all identified errors are corrected and the file is revalidated successfully. Escalate if validation fails again after correction.

The Approver obtains approval to furnish and file by confirming the draft package is complete and authorizing release through the approval workflow. Measurable criteria: 1 recorded approval before furnishing or filing. Expected outcome: authorized approval is recorded for furnishing and filing. Escalate if approval is missing or incomplete.

The Filing Specialist furnishes employee statements by the deadline using the approved ACA reporting system and delivery process. Measurable criteria: 100% of Forms 1095-C furnished by the applicable deadline. Expected outcome: employee statements are delivered on time and delivery evidence is retained. Escalate if any statement cannot be delivered by the deadline.

The Filing Specialist files Forms 1094-C and 1095-C with the IRS through the approved portal or transmitter after confirming the final file matches the approved draft. Measurable criteria: 1 successful transmission and 1 retained filing confirmation. Expected outcome: the transmittal and employee forms are submitted successfully and filing confirmation is retained. Escalate immediately if transmission fails or confirmation is not received.

The Records Coordinator archives supporting documentation by storing source data, coding rationale, approvals, and filing confirmations in the controlled repository according to the retention policy. Measurable criteria: 100% of required records archived with traceability to the filed forms. Expected outcome: all supporting records are stored in the controlled repository with traceability to the filed forms. Escalate if any required record is missing from the archive.