Note: This article does not apply to EZ Receipts accounts.
We’ll notify you if we are unable to process a claim for reimbursement.
To view the status of a claim, and see the details of any denial:
Log in to your account
Select the account
Select View Claims or View Claims and Payments
Select the claim from the list to view details.
Below are some common claim denial reasons, what they mean, and what you can do about them.
Denial Reason | What it means | What you can do about it |
Needs Info | The documentation received is missing one or more of the five required data elements. | Attach to the denied claim documentation that shows: Date of Service, Description of service or item, recipient of service, service provider and amount. |
Not an eligible date | The service or item represented on the documentation is for a date that is outside of your plan year. | Review the starting date and spend it by dates for your account. If you have another account from which this service or item would be eligible, you may submit a new claim against that account. Be sure to submit it to the correct account based on the date of service (not date of payment). |
Not an eligible benefit | The service or item represented on the documentation is not an eligible expense for this account. | Review the eligible expenses for your account. If you have another account from which this service or item would be eligible, you may submit a new claim against that account. Examples of this include an expense that is not eligible from your HRA may be eligible to be reimbursed from your FSA. |
Letter of medical necessity (LMN) | Certain expenses are not eligible for reimbursement from an FSA or HRA unless a Letter of Medical Necessity is provided from a licensed medical practitioner specifying the medical condition and necessity of the expense. | Attach to the denied claim a Letter of Medical Necessity. The IRS requires that the Letter of Medical Necessity Includes: the full name of the Patient, the full name and credentials of the physician (e.g., MD, DO), a description of the condition including the diagnosis, clear explanation of the recommended treatment(s), item(s) or service(s) and duration. |
Duplicate claim | This claim has previously been considered for payment. | If you have already been reimbursed for an expense, you will not be able to claim it again. Verify that the expense has not been submitted under another claim. If it is for a recurring expense, make sure that the date you submitted for this claim is correct. |
Election Exceeded | This claim exceeds the election in your account and therefore will not be eligible for payment from your account. |
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Balance Forward | The documentation received only shows the amount left to pay on your service (balance forward) and not the original charges from the service provider. | Submit the documentation from the Service Provider that shows the original services received. This documentation should be attached to the claim that was denied. |
Needs Explanation of Benefits (EOB) | Your plan requires that claims are submitted with an Explanation of Benefits as documentation. | The Explanation of Benefits (EOB) is illegible, incomplete, or missing. Please attach a legible EOB and documentation showing date(s) of service, description of service, recipient of service, provider, and amount to your denied claim. |
If you are submitting a new claim or attaching new documentation, please remember that the IRS requires that documentation shows: Date of service, Description of service or item, Recipient of service, Service Provider, and Amount.
Appeals Process
If you’ve provided accurate information and documentation and need to appeal a claim that has been denied, it must be submitted in writing by mail or fax.
Submit your request for a decision reversal in writing to the HealthEquity Appeals Team within 180 days (or 6 months) of the date of the original denial. It takes 30 days to notify a member of the appeal decision or outcome, and communication will arrive via postal mail.
You should submit additional information related to your claim as part of the appeal. Documents can include written comments, medical records, letter of medical necessity from your healthcare provider, and any other information you feel will support a decision reversal.
You may submit three ways:
Upload a completed Claims Appeals Form in the Member Portal under Manage General Forms. Include all supporting documentation.
Mail your appeal to HealthEquity, Attn: Reimbursement Accounts
PO Box 14374 Lexington, KY 40512Fax to 801.999.7829
Please note that HealthEquity EZ Receipts accounts require appeals to be sent to a different address. If you are unsure of your account type, please log in for assistance.
Note: Do not fax or mail this form to any other number or address unless instructed by HealthEquity’s Member Services. Documents sent to any other destination not under our instruction will be discarded for privacy/security purposes and will not be considered a properly filed appeal.