Note: This article applies only to HealthEquity EZ Receipts accounts.
We’ll notify you if we are unable to process a claim for reimbursement. Below are some common claim denial reasons, what they mean, and what you can do about them.
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.
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. Documentation from the provider must include the date(s) of service, description of service, recipient of service, and amount. | Submit a new claim with documentation that shows: Date of Service, Description of service or item, recipient of service, service provider and amount. In most cases, the best documentation for a medical claim will be an Explanation of Benefits (EOB) from your insurance provider. |
Not an eligible date | The service or item represented on the documentation is for a date that is outside of your plan year. | According to our records, you were not enrolled in the plan on the date of service. Please verify the service date and consult with your HR team if you believe this to be incorrect. |
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. |
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. | Submit a new claim with the original documentation and 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 and matches the documentation submitted. |
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 resubmit your claim including a legible EOB and documentation showing date(s) of service, description of service, recipient of 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. It cannot be done online in your HealthEquity EZ Receipts account or mobile app.
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.
The request must be addressed to:
HealthEquity Appeals Team
PO Box 14034
Lexington, KY 40512
Or Fax to 877.220.3248
Do not fax or mail your appeal to any other number or address unless instructed by HealthEquity’s Member Services. Documents sent to any other number not under our instruction will be discarded for privacy/security purposes and will not be considered a properly filed appeal.