This article applies only to EZ Receipts accounts, please see details about other HealthEquity accounts here: https://help.healthequity.com/en/articles/5647895-understand-and-resolve-claim-denials
We’ll notify you if we are unable to process a claim for reimbursement. Some denied claims require additional documentation you’ll need to submit in your online account. You aren't able to delete a claim after it has been submitted, but you can submit a new claim or edit a claim.
Find out how to resolve some of the common claim denials by following the links below:
Claim Denial Codes and Resolution
16 - Unclear information
18, 19 - Duplicated claims
20 - Duplicated claims
33 - Ineligible expense
Claim Denial Code Details
Edit/Cancel a claim denied due to incorrect information
If you entered something incorrect in your submitted claim (for example, a mistake on the description of services, date, provider, address, etc.), you will need to submit a new claim with the corrected information. You won’t be able to cancel or delete a claim once it has been submitted for reimbursement in your account.
2
Unclear Information and Ineligible Expense
The description of the service is missing or unclear on the documentation submitted.
To Resolve:
Select View Claims & Payments, click on the denied claim(s) and click Submit Receipt to upload an Explanation of Benefits or other statement that shows the services provided.
Documentation must include a description of the service.
4
Unclear information: receipt does not include date of service
The receipt or other supporting documentation does not indicate the date the expense was incurred.
To Resolve:
Click View Claims & Payments, click on the denied claim(s) and click Submit Receipt to upload new receipts or documentation indicating the date on which services were provided or the item was purchased.
Check the date and make sure this is not a prepayment for services rendered.
7
Service Not Eligible
The type of service listed on the claim is not an eligible expense. This product/service is not an eligible expense as defined by the terms of your program sponsor's plan.
To Resolve:
Prior to making purchases, determine which expenses are eligible, and if the expenses require a doctor's note or prescription to be eligible for reimbursement.
If you need to make a repayment to your account for an ineligible expense, you can click on Submit Repayment and make a payment online.
For a check, the form is found under Submit Receipt or Claim, then Card Receipt, and then click Print Form for Mail.
9
Unclear information and Letter of Medical Necessity
There was no Letter of Medical Necessity on file or submitted with the claim.
This expense is eligible only under certain conditions which must be verified by a written statement from your doctor.
To Resolve:
Read about the specific requirements for a letter of medical necessity and have one completed and signed by your doctor. It needs to clearly specify your medical condition and the medical necessity of this expense as it relates to that condition.
Make sure the provider completes the Duration field and does not leave it blank or the claim will be denied. Duration can be listed as “lifetime” for chronic conditions.
You will then need to submit a new claim with all your paperwork and this written statement from your doctor.
12
Service Date Outside Plan
This claim will show a received date after the “Claim It By” date for the plan it would be eligible to pay from.
To Resolve:
For a denied claim, there is no further action you can take. Your claim was denied due to the service date being outside of any plan year(s) that are currently accepting claims for; as a result, this claim is denied as ineligible.
For a denied card receipt: Your receipt was denied due to the service date being outside of any plan year(s) that are currently accepting claims for. You may have the option to submit a substitute receipt for a different service that you incurred out of pocket expenses for and has a service date that falls within the plan year that the card was used in.
To submit a substitute receipt, you may upload additional documentation to the original claim or by uploading the additional documentation as its own stand-alone submission.
To add additional documentation to the original submission, click View Claims & Payments, click on the denied claim(s). Click on the Denied Claim box and upload your substitute receipt.
15
Unclear information—partially denied claim
The receipt submitted does not provide the information we need to substantiate this expense.
To Resolve:
Click View Claims & Payments, click on the denied claim(s) and click Submit Receipt to upload new receipts or documentation.
Please make sure that your documentation from your provider includes:
- Patient's Name
- Provider's Name
- Date of Service
- Type of Service
- Expense IncurredLearn more about documentation requirements.
16
Unclear information
The receipt submitted does not provide the information we need to substantiate this expense.
To Resolve:
Click View Claims & Payments, click on the denied claim(s) and click Submit Receipt to upload new receipts or documentation.
Please make sure that your receipts and documentation include the following five pieces of information:
- Patient's Name
- Provider's Name
- Date of Service
- Type of Service
- Expense IncurredLearn more about documentation requirements.
18, 19
Duplicated claims
This claim is a duplicate of a previous Pay Me Back submission on the account.
To Resolve:
No further action is required on your part.
You have submitted an expense for reimbursement that was previously approved via a Pay Me Back or Pay My Provider claim.
Payment can only be made from your account once for the same expense.
20
Duplicated claims
This claim is a duplicate of a payment made on the HealthEquity® Visa® Health Account Card.*
To Resolve:
No further action is required on your part.
You have submitted an expense that has been successfully matched to a Healthcare card transaction.
We have substantiated the outstanding card transaction with this documentation.
33
Ineligible expense:
The expense submitted is not eligible for this account. You have submitted an expense that does not qualify due to the definition of eligible expenses under your account. This account restricts eligible expenses to vision and dental.
To Resolve:
Prior to making purchases, determine which expenses are eligible, and if they require a doctor’s note or prescription to be eligible for reimbursement.
Search eligible expenses.
If you need to make a repayment to your account for an ineligible expense, you can click on Submit Repayment and make a payment online.
For a check, the form is found under Submit Receipt or Claim, then Card Receipt, and then click Print Form for Mail.
Appeal a denied claim
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 online account.
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.
The request must be addressed to:
HealthEquity Appeals Team
PO Box 14034
Lexington, KY 40512
Or Fax to 877.220.3248
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.