In order for your claim to be in good order there is specific detail that is required. When submitting a claim be sure to include a receipt or Explanation of Benefits (EOB) with the following information:
For Medical FSA Claims:
- Date service was rendered (Medical FSA claims are based on date of service, not date of payment, with the exception of orthodontia which is based on payment date)
- Description of service or item
- Name of provider of service
- Name of person receiving the service
- Total out-of-pocket cost
- A credit card payment receipt is not sufficient documentation
For Dependent Care Claims:
- Date services were rendered
- Name of service provider
- Amount charged
- Name of person receiving service (dependent)
- Tax ID# or SSN of the provider
- Signature of the caregiver on claim form or receipt from caregiver
