Submitting Information for FSA Reimbursement

Posted by BAS - 21 April, 2022

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Employers using BAS for flexible spending account plan claim reimbursement management may wish to remind employees about the documentation needed to submit a claim. BAS reviews claim submissions and uses employers’ plan guidelines, along with IRS rules, to determine if a claim is eligible for reimbursement.

Documentation Needed with Claim Submission

Health Care FSA

When submitting a claim for reimbursement from a Health Care Flexible Spending Account or Health Reimbursement Account, a participant must provide documentation of the qualified expense.

An acceptable health care FSA claim should include:

  • Appropriate claim form. (Separate claim form for each individual)
  • Sign the form
  • Date the form
  • List expenses
  • List dates of service
  • Identify whose expenses (participant, dependent)
  • Identify dollar amount of claim
  • Include appropriate supporting documentation (see below)

Supporting Documentation

Supporting receipts, EOBs or billing statements must be submitted with the completed and signed claim form. Supporting documentation must contain all of the following elements to be considered adequate documentation under IRS rules. Credit card receipts and/or cancelled checks are not adequate documentation.

Medical Service – (An itemized statement or an EOB from the insurance company or health care provider that contains the following)

  • Patient Name
  • Provider Name
  • Date of Service
  • Description of Service (or procedure code)
  • Amount Paid

Medical Item

  • Merchant Name
  • Date of Purchase
  • Description of Item
  • Amount Paid 

Prescription

  • Name of Patient
  • Name of Pharmacy
  • Date (fill date, not pick up or payment date)
  • Prescription Number
  • Amount Paid 

OTC Drug or Medicine

  • Merchant Name
  • Date of Purchase
  • Description of Item (specific product name - “cold medicine” or “allergy medicine” not sufficient)
  • Amount Paid

Dual Purpose Item

If the item has both a medical and a non-medical purpose (a massage, nasal strips, vitamins, or compression socks, for example), a Letter of Medical Necessity from the participant’s doctor should be submitted confirming that the item is for medical care.

To be acceptable, a Letter of Medical Necessity must include:

  • Patient Name
  • Doctor Name
  • Date of Issue
  • Diagnosis
  • Service or Supply Needed
  • Statement or support that service or supply is medically necessary to treat diagnosis
  • Length of Service (if applicable)

Dependent Day Care FSA

When submitting a claim for reimbursement from a Dependent Day Care Flexible Spending Account, a participant must submit a completed BAS Dependent Day Care FSA Claim Form, along with appropriate receipts showing the expense was incurred for an eligible dependent.

An acceptable Dependent Day Care FSA claim should include:

  • Appropriate claim form. Separate claim form for each individual.
  • Form signed
  • Form dated
  • Qualified dependent identified
  • Provider’s signature and date (or provide receipt)
  • Taxpayer Identification Number (or SSN) (or statement that you tried to get the TIN/SSN but couldn’t)
  • Description of services
  • Dollar amount of claim
  • Include appropriate supporting documentation (see below)

Supporting Documentation

If the Provider does not sign and date the completed form attesting to each expense, supporting bills/receipts must be submitted with the completed claim form. A bill/receipt must contain all of the following elements to be considered adequate documentation under IRS rules. Credit card receipts and/or cancelled checks are not sufficient.

  • Name of Qualifying Dependent
  • Name and Address of Provider
  • Date of Service
  • Description of Service (if not evident from name on statement)
  • Provider’s Taxpayer Identification Number/SSN (if not on claim form or if statement not provided that tried to obtain the TIN/SSN)

Employers using BAS for FSA services can remind participants of claims submission guidelines.

Topics: Dependent Day Care FSA, Healthcare FSA, MyEnroll360 Feature, MyEnroll360, MyEnroll360 News


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