Debit Card Documentation Requirements

IRS rules and regulations that govern the spending accounts and debit cards dictate that transactions must be verified in order to be considered eligible. We understand that it can be frustrating to have to submit documentation after you’ve used your debit card, but the regulations are clear that it is your responsibility to be able to substantiate all transactions. Therefore, please save all documentation in case you need to provide it later.

• Note that an item being declined doesn’t necessarily mean that it is not eligible; it may just be that the item can sometimes be considered for general health or personal well-being (requiring a letter of medical necessity to be eligible). You may still be able to submit a manual claim to have the item reimbursed if it is a medically necessary item. Any balance for items that are not eligible for purchase with the card will require a different form of payment.
• You must return acceptable documentation in a timely manner. You can upload the documentation via your online account at app.thrivepass.com, fax, e-mail, or mail. Be sure to include a copy of the request letter if you use FAX, email or mail.
  
  Please note, ThrivePass will send three communications via email (or mail if no email is available). If no action is taken to return acceptable documentation within 90 days, the card will be suspended.
• IRS regulations require that documentation must contain specific information; we must be able to determine what portion of the cost is patient responsibility. An Explanation of Benefits (EOB) from your insurance company is most often the best type of documentation because it includes the necessary information.
• Per IRS regulations eligibility is based on the date of service, not the date you received the statement or have paid the expense.

What if I am unable to submit an EOB?

If you are unable to submit the EOB, submit an itemized statement from the provider that includes all of the following:

• Date of service (not date paid)
• Patient name
• Provider name
• Detailed description of service
• Total charges for the service
• Insurance payment, if applicable (not an estimate)

Unacceptable Documentation Examples

• Canceled check
• Credit card receipt/statement
• Cash register receipts
• Balance forward or balance due statements
• Payment on account receipt

Most Common Documentation Problems

• Cash Register or Credit Card Receipts typically only provide the date on which you made payment and do not include the actual date of service or an adequate description of the item purchased, or service rendered.
• Balance Forward Payment on Account typically does not have enough information about the date or type of service in order to substantiate the expense.
• Insurance Pending / Insurance Estimate if insurance has been filed, is pending or is an estimated amount, we will need to see an Explanation of Benefits or itemized statement from the doctor or dentist that includes the final patient responsibility amount after the insurance processes the claim.

Card Transaction Approval and Substantiation Process

The information we receive for card transactions is limited to the data collected by the MasterCard system. This system does not provide us the patient’s name, the actual service provided/or name of product purchased, or the date the service was provided. These are all required for plan usage.

*Transactions may be ‘auto substantiated’, meaning submission of receipts is not required, if the employer is using our copay matching, claims feeds, recurring expenses, and/or the Inventory Information Approval System (IIAS) options to auto substantiate card swipes for their participants.

For card transactions that require substantiation, we contact the participant in the following way:

• DAY 1
  The participant swipes the card and substantiation is needed. The card swipe will display in a ‘New’ status in the ‘Transaction History’, within the participant portal, and mobile app.
• DAY 45
  ThrivePass emails (or mails if no email is on file) a letter to the participant showing all the information about the card swipe and the information needed to substantiate the transaction. The card swipe will display in a ‘Pending’ status in the ‘Transaction History’, within the participant portal, and mobile app.
• DAY 75
  ThrivePass emails (or mails if no email is on file) a 2nd reminder letter requesting the same information.
• DAY 90
  ThrivePass emails an ineligible letter alerting the participant that their card is temporarily suspended. At that time the card swipe moves to an ‘ status and shows as a ‘Balance Due’. The debit card is suspended until the transaction is resolved (per IRS rules).

If at anytime during this process:

• Substantiation is provided showing full transaction was for eligible services it will be changed to an ‘Approved’ status, the card will be reactivated, and letters will no longer be sent.
• Documentation is provided that is not sufficient to approve some or all of the transaction, the card swipe will change to ‘Insufficient Documentation’. The insufficient documentation letter will be sent at this time to inform the participant that action is needed. If sufficient
  documentation is not provided after 15 days, ThrivePass emails an ineligible letter alerting the participant that their card is temporarily suspended. At that time the card swipe moves to an ‘Ineligible’ status and shows as a ‘Balance Due’. The debit card is suspended until the
  transaction is resolved (per IRS rules).
• Documentation is provided showing some or all the transaction is ineligible the card swipe will immediately change to an ‘Ineligible’ status, the amount will show as a balance due, and the debit card will be suspended until the transaction is resolved. The ineligible letter will be sent at this time to inform the participant that action is needed.

Balance Due Transactions

How to take care of a transaction that has become a Balance Due. If the participant does not provide valid documentation or the service/item is ineligible they have several options for correcting the balance due:

• They may submit a manual claim for eligible expenses that have not already been reimbursed we will use that claim to offset the balance due instead of issuing a reimbursement to them. We refer to this as an ‘Offset’ claim.
• They can ask the provider to credit their card with the amount of the balance due.
• They may pay their balance due via the Participant Portal or Mobile App with their banking information. We will post this against the balance due, add that amount back into their available balance, and release the transaction.
• They may send a check payable to ThrivePass. We will post the check against the balance due, add that amount back into their available balance, and release the transaction.