FSA claims 101: A step-by-step through claim reimbursement

What do flexible spending account (FSA) participants desire? They might tell you that they want an efficient way to save money on FSA-eligible expenses. Providing that experience requires processing that leads to fast reimbursement of participants’ FSA claims. 

So what does the FSA claims process look like after a participant purchases FSA-eligible expenses? Please note: Depending on the administrator, you will likely find a different experience when participants pay out of pocket versus using their benefits card. 

When expenses are paid for with a benefits card

This process starts with the participant simply swiping their benefits card at the point of sale. For WEX participants, that means the claim has already been submitted and the merchant or provider has been paid. And, for 85 percent of claims with our WEX benefits card, the purchase is automatically approved without additional documentation needed. 

If the participant’s claim is not automatically approved, WEX will notify the participant to request additional documentation. Once documentation that meets the IRS’ requirements is received and approved, the claim is approved. 

For medical FSA claims, documentation should include: 

• Date service was received or purchase was made
• Description of service or item purchased
• Dollar amount
• Provider or store name

An Explanation of Benefits (EOB) typically contains the information required by the IRS.

When expenses are paid out of pocket

If the participant doesn’t have access to a benefits card or chooses not to use one, they will likely need to:

1. File a claim and submit documentation to be reimbursed from their FSA. 
2. The claim and documentation are reviewed to ensure the claim meets IRS requirements. 
3. Hopefully, the participant’s claim is approved and they are reimbursed! If not, they’ll be asked to submit additional documentation before they are reimbursed. 

WEX has also simplified the ability to upload documentation with EOB Smart Scan. Watch our video below to see how easy it is.

WEX receives compensation from some of the merchants identified in its blog posts. By linking to these products, WEX is not endorsing these products. 

The information in this blog post is for educational purposes only. It is not legal or tax advice. For legal or tax advice, you should consult your own counsel.