Substantiating a transaction

Substantiation is proof that the purchase is a qualified expense. Because health and benefit accounts are tax deductible, the IRS requires validation of all purchases made with these accounts.

Auto-substantiation

Many debit card transactions are automatically substantiated, generally including:

  • Copayments under your health plan
  • Prescriptions
  • Real-time verification at the point of purchase
  • Recurring payments

Good to know
Has your claim been denied? Check the Task section on the member website or the MyHealth app to find out if you need submit a receipt for your claim.

Substantiating a debit card transaction

If a debit card transaction is not automatically substantiated, you will need to provide documentation to verify the purchase was qualified. You will receive a notification letting you know what is required or you can check the Tasks section of the member website or mobile app to see if you have any transactions that require a receipt to be submitted.
See receipt requirements.

How to substantiate a claim

Member website and mobile app process

Graphic shows member website and mobile app process: Claim filed. Claim and supporting documentation reviewed. Substantiation complete and the transaction will be processed. Payment will be received within 2 to 3 business days via direct deposit, or a check sent within 3 business days. If documentation is needed, we'll send you receipt reminder notifications (up to three) requesting the proper documentation.

If we need additional information, you’ll receive a notification letting you know that more information/documentation is required before your claim can be paid. If we don’t receive documentation within 60 days, the claim will not be paid.

Manual/online claims notifications

Here is how we will communicate with you throughout the claims process:

  • 1st receipt reminder – sent 5 days after claim submission.
  • 2nd receipt reminder – sent 15 days after claim submission.
  • 3rd receipt reminder – sent 30 days after claim submission.
  • Request for More Information (RMI) – sent when more information is needed before your claim can be paid.
    Denial letter will be sent if additional documentation is not received.
  • Denial letter – sent 60 days after claim submission or if the claim is denied due to ineligibility.
  • Denial with Repayment – sent if a claim has been paid, but later determined ineligible.

Debit card transaction process

Graphic shows debit card process: Debit card purchase made. Transaction reviewed for auto-substantiation. Substantiation complete and the claim will be approved. If documentation is needed, we'll send you receipt reminder notifications (up to three) requesting the proper documentation.

After 40 days, if we haven’t received the documentation, or if the transaction is determined ineligible, you’ll receive a denial notice with a repayment request. If we haven’t received repayment after 60 days, the debit card for that account will be suspended.

Debit card notifications

Here is how we will communicate with you throughout the claims process:

  • 1st receipt reminder – sent immediately after debit card transaction settlement date.
  • 2nd receipt reminder – sent 15 days after debit card transaction settlement date.
  • Overdue notice – sent 30 days after debit card settlement date.
  • Request for More Information (RMI) – sent to let you know more information will be needed before your claim can be substantiated.
  • Ineligible notice – denial with repayment request sent 40 days after debit card settlement date or if the claim is denied due to ineligibility. If we haven’t received repayment after 60 days, the debit card for that account will be suspended.

How to submit documentation

You can submit receipts or other paperwork in one of these three ways:

Member website

  • Select “Tasks” > “Receipt(s) needed to approve your claims.”

MyHealth app

  • Select “Tasks” > “Receipt(s) needed to approve your claims.”

Fax

  • Fax the reminder notice with a copy of the receipt to 844.590.0919.

Note: You will receive a decision on reimbursement within 30 days after the documentation is received.