This article applies to your HealthEquity account only, details about EZ Receipts accounts can be found here: https://help.healthequity.com/en/articles/5124407-understand-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 won’t be able to delete a claim after it has been submitted; however, you can submit a new claim or edit a current claim.
Claim Denial Reasons and Resolution
Balance Forward
Please resubmit itemized documentation showing date(s) of service, services provided, amount charged, patient and provider name for reimbursement. A Balance Forward statement is not a sufficient description of service.
Bank Statement
Bank statements are not sufficient documentation for reimbursement. Please resubmit itemized documentation showing date(s) of service, services provided, amount charged, patient and provider name.
Billed Date
A billed date is not always the date of service. For a claim to be eligible for reimbursement, please resubmit itemized documentation showing date(s) of service, services provided, amount charged, patient and provider name.
Capital Expense
This item requires a Capital Expense Worksheet. Only a percentage of this claim may be eligible for reimbursement.
Check Copy
A check copy is not an acceptable form of documentation. For a claim to be eligible for reimbursement, please resubmit itemized documentation showing date(s) of service, services provided, amount charged, patient and provider name.
Claim Form Needed
A completed reimbursement form is required when submitting a request. You may also request payment online by logging in to your HealthEquity account and submitting a claim for reimbursement.
Claims Integrated
Claims are submitted electronically by your insurance carrier to HealthEquity. Manual claim submission is not allowed.
DCRA Check Copy
The Dependent Care Reimbursement Account (DCRA) Check copy must show proof it has cleared your account.
DCRA Incomplete
The Dependent Care Reimbursement Account (DCRA) reimbursement form must be filled out in its entirety. Please resubmit a completed form signed by the provider.
DCRA Needs Information
The Dependent Care Reimbursement Account (DCRA) reimbursement requires provider, dates of care, and the amount charged or a completed DCRA reimbursement form signed by the provider. Please complete missing information and resubmit the claim.
Deductible Coinsurance and Copay
Only medical deductible, coinsurance and copay expenses are eligible for reimbursement. Please submit an explanation of benefits (EOB).
Deductible Coinsurance Only
Only medical deductible and coinsurance expenses are eligible for reimbursement. Please submit an explanation of benefits (EOB) statement.
Deductible Only HRA
Only expenses applied to the medical deductible are eligible for reimbursement. Please submit an explanation of benefits (EOB) statement.
Digital Signature
A physical or a certified signature is required with your completed claim form.
Duplicate Claim
This claim has been previously considered for payment.
Estimated Services
Documentation with an estimation of services is not a sufficient form of claim verification. Please submit an itemized receipt or explanation of benefits (EOB) statement after services have been rendered.
Illegible or Incomplete Document
The documentation submitted for reimbursement is not legible, is cutoff, or incomplete. Please resubmit a more legible/complete copy or upload documentation by logging in to your HealthEquity account.
Incomplete Reimbursement Form
Please resubmit a completed reimbursement form with documentation or log in to your HealthEquity account to request payment. The form must be filled out in its entirety.
Insurance Claim Form
An insurance claim form received from your health plan which states that a claim has been received is not sufficient documentation for reimbursement. Please submit an itemized receipt or explanation of benefits (EOB) statement showing amounts owed after insurance processing is complete.
Letter of Medical Necessity (LMN)
A letter of medical necessity is required from a licensed medical practitioner that includes a specific medical diagnosis and the recommended treatment for this claim to be processed for reimbursement. 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.
Limited Purpose Flexible Spending Account (LPFSA)
The service requested is not an eligible benefit under this plan. Only dental and vision expenses are eligible until your medical deductible has been met.
Marriage or Family Counseling
Marriage/family counseling is not eligible for reimbursement unless prescribed by a medical practitioner. A letter of medical necessity is required and must include a medical diagnosis.
Need Receipts
This request is missing supporting documentation for reimbursement. Please submit an itemized receipts/explanation of benefits (EOB) statement that includes provider name, patient name, date(s) of service, description of service, and amounts owed.
Need Information
Resubmit itemized documentation or log in to your HealthEquity account to upload itemized documentation for this claim. Please resubmit itemized receipts/explanation of benefits (EOB) statement that include provider name, patient name, date(s) of service, description of service, and amounts owed.
Not an Eligible Benefit
The service requested is not an eligible benefit under this plan.
Not an Eligible Date
The service date requested for reimbursement is outside the plan year.
Not Eligible/Letter of Medical Necessity (LMN)
The service or item requested is not eligible for reimbursement. A letter of medical necessity from a licensed medical practitioner that includes a specific medical diagnosis and the recommended treatment may be submitted for further review.
OB Global Billing
Global Obstetric Billing is not eligible for payment until actual services have been rendered. Please submit documentation showing actual dates and description of services for obstetrical care.
Orthodontia Contract
An orthodontia contract is required for this claim. Please submit an orthodontia contract that includes the treatment start date, total amount charged, duration of treatment, and monthly installment amounts for reimbursement.
Orthodontia Documentation
Please submit an itemized receipt of explanation of benefits (EOB) statement showing orthodontia services for reimbursement. Documentation must include provider, patient, description of service, amount charged, and date paid.
Patient Not Eligible
The patient is not an eligible dependent for this account.
Premium Payments
Documentation submitted is not sufficient for reimbursement. Please submit a monthly premium invoice or statement.
Prepayment
Please submit supporting documentation for reimbursement showing actual date(s) of service, provider, patient name, services provided, and amount charged. Prepayments cannot be paid until after services have been provided.
Run-out
Claim was submitted past the run-out date. Claims can no longer be submitted for this plan year.
Prescription
A prescription is required from a licensed medical practitioner that includes the item or service prescribed and the duration of treatment to be eligible for reimbursement.
Prescription/Letter of Medical Necessity
Some items and services may require a Letter of Medical Necessity or prescription to be eligible for reimbursement, which includes a specific medical diagnosis and treatment from a licensed medical provider.
Travel Expense
Travel expenses require proof of the medical visit to be eligible for reimbursement. Please submit an itemized receipt or explanation of benefits statement from a healthcare provider.
Your Responsibility
Submitted documentation shows your responsibility is less than the amount requested for reimbursement. Please submit documentation showing additional services and amounts owed.