Introduction
Claims for employee benefits, such as dependent care reimbursement and medical expense coverage, may sometimes be denied. The most common reasons involve missing or incomplete documentation. To help ensure your claims are processed smoothly, understanding the typical causes of denials and how to address them is critical.
Common Documentation Issues Leading to Claim Denials
Insufficient Receipt Details A receipt missing critical information is a frequent cause for denial. Ensure the following details are clearly included in your receipt before submission: - Provider name - Patient name (if applicable) - Date of service (important: this should be the date the service was provided, not the payment transaction date) - Description of service provided - Amount charged and paid
Missing Explanation of Benefits (EOB) For certain types of claims, particularly medical-related reimbursements , an Explanation of Benefits (EOB) from your health insurance provider could be the best type of documentation. If your claim involves medical deductibles, RX deductibles, or coinsurance, ensure a copy of your EOB is included in your submission as this document has everything the processors need to approve your claim.
Failure to Submit Medical Necessity Documentation For expenses like vitamins, which are not automatically eligible, additional documentation such as a Letter of Medical Necessity (LMN) is required. The LMN must clearly state that the vitamins are necessary to treat a diagnosed medical condition. Additionally, your receipt must include the recipient's name. Claims without this supporting documentation will be denied.
Resolving Claim Denials
If your claim has been denied, follow these steps to resolve the issue:
Review the Denial Reason Carefully read the denial notice to understand what’s missing or incomplete.
Submit Complete Documentation - Provide a detailed receipt or itemized invoice, including the information noted above. - Attach supplemental documentation like the EOB or LMN when required.
Resubmit the Claim Once all issues have been addressed, add a new receipt to your claim so it can get processed again.
By ensuring all documentation is thorough and accurate before submission, you can avoid common pitfalls and expedite the claim approval process.
Related Topics
How to obtain an Explanation of Benefits from your insurance provider
Guidelines for preparing an LMN for medical expense claims
For additional assistance, contact your benefits administrator or refer to your employee benefits plan documentation.