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Tips and tricks for submitting claims and getting reimbursements

Taking care of group benefits can be complicated. At BenefitHelp Solutions (BHS), we're here to help make it easy and convenient. Follow these steps to ensure your claims flow smoothly every time.

Submit claims using the online employee portal

As a member, you have access to your account(s) through an online portal, called WealthCare. Once you set up your account, you can log in to:

  • Submit claims.
  • View the status and outcome of submitted claims.
  • Verify that payment of a claim has been sent.
  • Check your account balances.
  • Submit reimbursement requests.
  • Change your personal information, including your address.
  • Update your preferred reimbursement method (direct deposit or check).
  • Order a lost or stolen card.
How to setup your WealthCare account online

Setting up your account just takes a minute. Simply follow these steps:

  • Review your enrollment confirmation letter, which contains your enrollment ID number.
  • Log in to WealthCare at mywealthcareonline.com/benefithelpsolutions/resources. Use your ID number to get started.
  • Click the enrollment tab and follow the enrollment instructions.
How to submit a claim online

Once you're logged in to WealthCare, you can quickly submit a claim. Here's how:

  • Click on reimbursement request under My Accounts.
  • Add a new request and check the appropriate boxes.
  • Read through and acknowledge the certification
  • Click submit.
What can be reimbursed, and what do I need to include in my request?

Your health flexible spending account (FSA) only permits reimbursement for medical expenses allowed under Internal Revenue Code (IRC) section 213(d). In order to comply with these mandates, BHS will often request documentation of your medical care expenses.

The documentation needs to show that your claims meet the necessary requirements. We call this "substantiating documentation." BHS takes a detail oriented, conservative approach to compliance. Doing so protects both the employer offering the plan and the employees participating in it.

What usually doesn't need substantiation?

Some claims can be approved electronically. These are:

  • IIAS purchases using your benefits card
  • Pharmacy purchases using your benefits card
  • Payment for copays using your benefits card
  • AutoPay claims (if you have elected to participate in the AutoPay feature)
What information does claims look for when I send in documentation?
  • A specific description of the service or product
  • The provider or vendor's name
  • The date of service or sale
  • The final out-of-pocket expense, if the expense is included in the major medical plan
  • The date the service was paid for, if applicable

Expenses that are already established medical care expenses will not require additional documentation. However, many expenses can be used for general health or have multiple purposes. In these instances, the expenses will require documentation beyond what is listed above.

I sent in a receipt. Why is that insufficient documentation?

Most receipts show final out-of-pocket expense and date of payment. However, all five items mentioned above are needed to process the claim. If you can't identify all five elements required from the document you are submitting, chances are BHS can't either.

When I have fully documented my claim, how does BHS determine whether to approve or deny it?

If the dates of service, member and amount are all eligible for reimbursement, BHS looks at the service description. Some services or supplies are always eligible for reimbursement, but others are potentially eligible and require additional documents to establish medical necessity, Other services are never eligible, even if prescribed by your health care provider.

Our claims processors use the eligible expenses list to make decisions about whether a service is reimbursable, and if we need additional documents to reimburse your claim. You can find the eligible expenses list at the following link, or on the BHS website: benefithelpsolutions.com/pdfs/fsa_expenses.pdf

Why do you need even more documentation?

Services and supplies that are potentially eligible or available over the counter often require more documentation to show that they are necessary to treat a specific medical condition. In these instances, BHS usually requires a valid prescription or letter of medical necessity filled out by your health care provider.

The eligible expenses list mentioned above addresses what kind of documentation is needed. If the expense you are seeking reimbursement for is not listed, please contact the BHS customer service team to help.

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