Claim Documentation Requirements

Claim documentation requirements:

Provider’s name.
Date and description of each service.
Charge for each service.
Taxpayer identification number for Dependent Care providers.
Name of person receiving services (as provided on the enrollment form).
Amount paid or denied by insurance (healthcare expenses only). A copy of the Explanation of Benefits is preferred.

You may find the following general information helpful in submitting documentation to substantiate your Flexible Spending Account eligible expenses:

Deadlines for Filing claims:
The SISC Flex plan year is January 1st through December 31st each year. Participants have 90 days (run out period) following the end of the plan year to file claims for the current year. Expenses for all claims must be incurred during the current plan year, or the grace period (2 1/2 months following the plan year end) associated with that plan year. All claims and supporting documentation must be received by the SISC office no later than March 31st in order to be considered filed during the run-out period.

Prescription Medication Purchases:
Documentation may include the Rx tickets, cash register receipt (w/ date and Rx numbers), or a printout from the pharmacy, which shows the date, Rx name or number, patient name, and co-pay amount.

If your prescription drug coverage is through Medco, you can print prescription order information history online at:  http://www.medcohealth.com
You'll have to register if you haven't done so previously.  Click on the Prescriptions & Benefits tab, then click on Claims & Balances.  Make sure the documentation includes: the patient name, Rx name or Rx number, co-pay amount, pharmacy name, and date ordered.

Medical, Dental, and Vision Services
The preferred documentation is the Explanation of Benefits (EOB) Form from insurance.  Acceptable documentation may also include a detailed ledger or statement, which includes provider’s name and address, patient’s name, date of service, description of charges, and the amount for which patient is responsible to pay, after insurance. 
 
Online Documentation of Medical Visits and Services:
If your medical coverage is through Blue Cross, Explanation of Benefits (EOB) Forms can be printed from the Blue Cross website: http://www.anthem.com/ca/sisc/
If you have not already done so, you'll need to register on the site – look for: "New Users, please register here."  Then, just follow the prompts.  Once you register, under MEMBER SERVICES, Click VIEW CLAIMS (MEDICAL).  Select the date you want to view, then print.

If your medical coverage is through Blue Shield, detailed claims information may be obtained from the Blue Shield website: https://www.blueshieldca.com
You will need to register on this site to view your claims in addition to plan coverage and benefit information.

Online Documentation of Vision Services:
If your vision insurance is through Vision Service Plan (VSP), you may print a VSP Savings Statement online. Visit http://www.vsp.com
Click on Members & Consumers, complete registration if you haven’t done so previously.  Once you’ve signed in, click on Previous Visits and Savings.  Select a date of service, and print the savings statement.

Online Documentation of Dental Services:
If your dental coverage is through Delta, Explanation of Benefits (EOB) Forms can be printed from the Delta website.  If you have not already done so, you'll need to register on the site.
Visit http://www.deltadentalca.com/  Click on Enrollees, then click on Checking your benefits online, click on your plan (eg: Delta Dental), then click on Enrollees.  You will be prompted to log in or register if you haven’t done so previously.  Click on Check claims status, then Claims list, then Prior claims, then Claim details, and print this screen.

Always remember to submit a signed SISC Flex Claim Form with your documentation.   Forms can be downloaded at http://sisc.kern.org/flex/forms.html