When someone pays out of pocket for a qualified expense, they can submit a claim for reimbursement. Here's how to approve or deny claims.
How to review claims
Select the Claims tab from the side menu.
Choose an unresolved claim from the dashboard.
Select Start Reviewing to mark the claim as under review.
Review the claim details.
Decide on the claim status:
To return the claim to the member requesting additional information, select Needs Information.
Approve or Deny the claim if you have all the necessary information.
Claim decision communications
Approved or Denied claims will notify the member of the decision. However, notifications may be disabled based on partnership agreements.
Unresolved and resolved
You and your team will likely spend most of your time working in the Unresolved tab, where you can review submitted claims. The Resolved tab is where you can see all approved and denied claims.
Claims snapshot
The unresolved claims snapshot gives you a quick overview of your team's progress and workload, as the view filters unresolved claims by status and their time in the queue
Claim statuses
Here is an overview of the possible claim statuses.
Status | View | Definition |
New | Unresolved | Unopened new claim |
Updated | Unresolved | Claim resubmitted with requested info |
In Review | Unresolved | Under review by support agent |
Information Requested | Unresolved | Requested new information from member |
Approved | Resolved | Support agent has approved claim |
Payment Pending | Resolved | Payment process has been initiated |
Paid | Resolved | Payment has been made |
Denied | Resolved | Claim has been denied by agent |
Plan details
To access plan details, select the benefit listed on the claim's benefit field. The Plan Details view will provide an overview of:
Plan Period
Grace Period
Run-Out Period
Receipt Requirements
Eligible Expenses
And Merchant Categories
Claims activity
To review claim history and internal notes, scroll to the Activity tab of the claim.