Top 3 Tips For Year End Claiming

The end of the benefit year is busy, and we often get claims with the wrong documentation. In some cases, employees fail to get reimbursed because they don't have time to resubmit before their deadline. 

To help avoid this situation, avoid the 3 common mistakes outlined below. 

1. Insurance was involved and you didn't send us their 'Explanation of Benefits' 

Often we receive receipts that show that an employee has insurance coverage. This can be coverage from a group plan or a spousal plan.

Any time there is insurance coverage involved we require the detailed Explanation of Benefits document (EOB, sometimes called a Claim Statement) from all insurance providers including other HSAs, for each expense you are claiming. 

This detailed document is issued directly by your insurance provider(s) and shows the treatment/service date, patient name, treatment/service details, total cost of treatment, the amount paid toward each expense (even if it is 0) and all applicable messaging/notes for each expense regarding why insurance paid the amounts they did. 

If you do not have your copy, contact your insurance provider directly to obtain it. Please note, online copies or screenshots are acceptable. Summary documents are not acceptable as they do not include all of the required details listed above.

If you don’t have other coverage for your expense(s), submit to National HealthClaim directly.

2. The receipt shows payment date when we really need treatment date

Just submitting a payment receipt does not tell us the information we need.

Make sure you get a detailed invoice that includes the date of the treatment and details of what the treatment was. 

For Dental Claims (if you do not have insurance coverage) send us the Standard Dental Claim Form. It includes all the information detailed above. 

Of course if you have insurance coverage, send us the Explanation of Benefits from your carrier instead (see point #1).

3. Your Orthodontic claim is missing information

For orthodontic treatment expenses submit a copy of each payment receipt. The payment receipt must clearly indicate the expense is for Orthodontics and what kind of expense it is (Deposit/Initial Payment/Monthly Installment). The receipt must include the patient name, amount and the date of the payment.

IMPORTANT: If you have any insurance or other coverage for orthodontic treatment, you must provide additional documentation. Your first orthodontic claim must include the Orthodontic Treatment/Financial plan, which shows the patient name and payment schedule you have arranged with the dentist. We will keep this plan on file so you will need to submit it only once.

When there is any insurance or other coverage for orthodontic treatments, you must submit the expenses to them first. They will process the claim according to the payment schedule and provide you with an Explanation of Benefits document (EOB, also sometimes called a Claim Statement). We require the EOB document for each payment you are claiming when other coverage has been involved.

Regarding lump-sum payments, please be aware that we cannot reimburse lump sum payments if there is any other coverage involved with your orthodontic claim. If you have other coverage, you must make payments according to the payment plan that your insurance company is following.