Why are employees being asked for documentation after a substantiation feed has been established with the insurance carrier?

February 14, 2018

Are you hearing from your clients and/or employees that they still have to substantiate debit card purchases when a feed is provided by your dental carrier, pharmaceutical benefits manager and/or health insurance carrier? If so, the following tips and tricks will help decrease the need for substantiation and ease your administrative burden.

Pay for Prescriptions One at a Time

The information in the feed that comes from the carrier lists each prescription individually, so if multiple prescriptions are purchased in one transaction, the amount of the transaction will not match any of the amounts listed in the feed. If the amount of the transaction does not match, the transaction cannot be auto-substantiated. Paying for prescriptions one at a time is a good solution.

Pay for Each Patient’s Account Separately

When a participant uses their card to pay a healthcare-related bill, the bill is often for multiple patients. This is especially the case when paying dental bills or pediatric bills from the same dentist or doctor. When carriers send claims information for these providers, they do not combine dates of service or claims for multiple patients. The claims are typically processed individually by patient and then by date of service. To have a better success rate, it is best to pay separately by patient and date of service.

Remember Claim Lag Time

While claim processing has become faster in recent years, it is typical for documentation to be requested from participants before the claim is substantiated automatically by the incoming feed. Typically, if a participant receives a secondary itemized receipt request, they should provide separate substantiation.

Always Save Your Receipts

It is important to remind participants that they should always get an itemized receipt from the provider at the time of service. The IRS requires that participants have these receipts in the event of audit.