Flexible Spending Account/Health Reimbursement Account Denied Claims

Posted by BAS - 06 September, 2012

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Each week, BAS receives more than 2,500 flexible spending account and/or health reimbursement account claims. Approximately 85% of claims submitted to BAS are properly filed and substantiated, and, subsequently, reimbursed during the weekly claims reimbursement on Tuesday. However, some claims cannot be paid because the substantiation supporting the claim does not contain sufficient information. Common examples of receipts that do not contain enough detail to substantiate a claim include: cash register receipts for prescription copays; provider payment receipts that do not contain dates of service or the reason for the expense; and receipts for services or items with both a medical and non-medical purpose (also known as dual-purpose items or services) that are not accompanied by a physician’s letter of medical necessity.

Many FSA/HRA plans offer a period for participants to cure denied claims. For plans subject to ERISA, the period is typically 180 days or more from the date the claim is denied. Correcting a claim that was denied because of inadequate substantiation can be easy. We offer suggestions below to assist with correcting a denied claim.

1. Identify the claim that was denied and the reason for the denial. Log on to www.MyEnroll.com and from the left hand menu click on the Enter FSA Claims Online tab and then choose the Submitted Claims History tab. Locate the batch number associated with your claim denial and click on the blue hyperlink to review the Batch Details. Click on the code for a brief description of the reason the claim was denied.

2. Obtain an Explanation of Benefits or a new itemized receipt to substantiate the denied claim. Evaluate the claim and supporting receipt(s) to determine what information is needed.

3. From the FSA Claims Entry - Batch Details screen check off any of the denied items that you would like to re-submit additional information and then select the Resubmit All Selected Claims button. You will be prompted to upload a copy of your additional documentation and last, certify and submit your claim.

If you have questions about Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA), please contact us, as follows:

  • HR Administrators and Brokers: contact your Account Manager, or email Service@BASusa.com, or call 800-945-5513, option 4.

Topics: MyEnroll360 Feature


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