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Review member claims for reimbursement
Review member claims for reimbursement

Learn how to review claims and help members get reimbursed.

Updated over 3 months ago

When a member pays out of pocket for a qualified expense, they can submit a claim for reimbursement. Here's how administrators can approve or deny claims.

Claims dashboard

The claims dashboard will show the following:

  • Number of open claims and how long they have been open

  • Member name

  • Benefit type

  • Claims status

  • Organization

How to review claims

From your Claims dashboard, follow these steps:

  • Select and open the desired claim.

  • Review the claim details.

  • Leave notes as necessary, and

  • Select Approve or Deny.

Refer to plan details and company guidelines for approval or denial of claims.

Member communications

Approved or Denied claims will notify the member of the decision. However, notifications may be disabled based on partnership agreements.

Claim status

Status change

Opening a New claim will change its status to In Review.

Let's get familiar with each status below.

  • Approved: A claim that has been approved.

  • Denied: A claim that has been denied.

  • In Review: An open claim that's in review.

  • New: A new and unassigned claim.

  • Pending-Info Requested: A claim returned to a member for additional information.

Benefit details

After opening a claim, select the benefit under the Benefit field to access the following benefit details that can be helpful for review:

  • Plan Details: Does the plan have a grace period? A receipt requirement?

  • Eligible Expenses: What categories of expenses are considered eligible?

  • Merchant Category Code: Where the card will be accepted?

Resolved claims

To revisit a processed claim, select the Resolved tab at the top of the Claims dashboard to view your claims history.

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