How it Works:
The participant visits a provider.
- During the visit the participant must obtain an itemized receipt or Explanation of Benefits (EOB) so they can submit the claim.
- The participant will submit the claim right away through the Ameriflex mobile app and/or online through their Ameriflex account
- Pay provider vs employee reimbursement
- How to set up direct deposit
What happens if the claim is approved?
The participant will see that it was approved on the Ameriflex mobile app and/or their Ameriflex account. They will also receive a confirmation email if they have an email address on file.
Will the participant be able to see the claim online in their Ameriflex account?
Yes, the claim will show as Approved, Pending or Denied. Approved transactions do not require any action. The “Pending” transaction will require additional action, as the transaction will need to be substantiated before it can be approved. A denied claim will also require additional action if the claim document did not meet the required information.
What happens if the claim is denied?
The participant will receive a letter (see example below) or email stating the reason why their claim was denied. Here is a list of some reasons why the claim may be denied:
- Letter of medical necessity (LMN) required
- Helpful Link: Why would I need to submit a Letter of Medical Necessity for an eligible expense?
- The EOB and/or itemized receipt may be missing information.
The itemized receipt must contain the following information:
- Name of Provider
- Name of Participant/Dependent
- Explanation of services rendered
- Amount of the transaction
- Date of Service
- Non eligible service/product
- The date of service falls outside of the plan year
- It could be a duplicate claim that was already filed
- The plan was terminated or the participant was terminated
- A dependent aged out for the dependent care plan or not linked to health reimbursement arrangement plan
Sample Claim Denial Letter
Can the employer view transactions from the Ameriflex employer portal?
Yes, employers can access participant information in the Ameriflex employer portal to view claims, deposits, and card transactions.
What can the Participant do if they have questions or want to resubmit their claim?
- The Participant can contact our Participant Services team directly for assistance at:
- Phone - 888.868.3539
- Email - email@example.com
- Chat: Go to myameriflex.com and click on the Live Chat button at bottom right hand corner of the screen
- The Participant can resubmit the claim with the required information.
Can the participant get reimbursed via direct deposit?
Yes. For additional information, please see “Reimburse out of pocket expenses” direct link below.
Here is a list of frequently asked questions you might hear from your participants about manual claims. Note: There is a hyperlink within the questions, so hover over and click the link to be directed to that specific article.
- What items are required for a receipt to be considered itemized? (check this article as it does not list the Participants name must be on the receipt).
- How do I download the Ameriflex mobile app? Non-HSA users only
- How do I set up to be reimbursed via direct deposit?
- How do I submit a manual claim?
- What is an Explanation of Benefits? Where can I get one?
Here is a list of frequently asked questions you might hear from your participants about denied manual claims.
- Why would I need to submit a Letter of Medical Necessity for an eligible expense?
- Is this service/product covered?
- Why is my receipt causing my claim to be denied?
- Why is my EOB causing my claim to be denied?
- What expenses are eligible for a dependent care account (DCA)?
- Why was my manual claim denied for transportation expenses?