The claims report lets you review claim activity, audit benefit usage, and track claim statuses. This report shows you all claims related to member benefits for selected organizations during the selected date range.
How to generate a claims report
From the Reports tab, select Generate Report.
Choose the claims report.
After entering your desired report parameters, select Generate.
Date Range
Report data will reflect the selected dates. The date range filters on claim date, which is the date the claim was submitted.
Claims report fields
Field name | Definition | Example |
Organization Name | Name of the organization, which is most often an employer. | Fresh Payroll Testing |
EIN (Employer Identification Number) | Employer identification number. May be blank for some orgs. | 11-1223459 |
Member First Name | The first name of the member. | Julian |
Member Middle Name | The middle name of the member. Optional; may be blank. | Allen |
Member Last Name | The last name of the member. | Barrows-Ernser |
UID (User ID) | Unique identifier for an individual (UID) created by our platform. | CYkgX24smPaEaLtIkR8Ild5XKsR2 |
SSN | The member’s Social Security number. Shows the full number or just the last four digits, depending on the option selected when the report was generated. | ***-**-5763 |
Employee ID | External employee identifier from the organization’s membership record. Blank when no organization membership record exists. | 100482 |
Benefit Type | Type of benefit (e.g., DC-FSA, FSA, HRA). | DC-FSA |
Benefit Title | User-friendly benefit name (e.g., Dependent Care, Healthcare FSA). | Dependent Care |
Benefit Offering ID | Unique identifier for a benefit configuration. | 56d95297-996c-4875-8daa-0c8a5b2edb03 |
Claim Date | The date the claim was submitted. | 2024-08-02 19:21:58+00 |
Submitted Amount | The dollar amount submitted on the claim. | 150.00 |
Approved Amount | The dollar amount approved for reimbursement. This is 0 until the claim is approved. | 120.00 |
Merchant Name | The name of the merchant from the card transaction. Blank for manual claims (see Card and manual claims section below). | CVS Pharmacy |
Claim ID | Unique identifier for the claim created by our platform. | 1ff2599d-774a-44e8-ac45-33d2211955ca |
Claim Status | The current status of the claim. See Understanding claim statuses below. | PENDING |
Last Update Date | Date the claim was last updated. (ISO 8601 format) | 2025-01-21 23:09:01+00 |
Claim in Review Date | Date the claim entered the “In Review” status. (ISO 8601 format) | 2024-08-02 19:27:07+00 |
Claim Pending Date | Date the claim entered the “Pending” status. (ISO 8601 format) | 2024-08-02 19:21:58+00 |
Claim Denied Date | Date the claim was denied. (ISO 8601 format) | 2024-09-01 11:15:38+00 |
Claim Approved Date | Date the claim was approved. (ISO 8601 format) | 2024-08-17 09:01:00+00 |
Claim Archived Date | This column is a placeholder for future use. It is always blank and should not be interpreted as meaningful data. | (blank) |
Relationship | Identifies the claimant as an accountholder or a dependent. Conditional: enabled only for certain organizations. See Accountholder and dependent claims below. | Accountholder |
Funding ID | Identifier for the associated funding event. Conditional: enabled only for certain enrollment providers. | 9452 |
Claims-based Funding Date | Date the claim was funded, or the next scheduled funding date. Returns “N/A” when claims-based funding is not enabled. When populated, dates appear in ISO 8601 format. Conditional: enabled only for certain enrollment providers. | 2024-10-01 11:15:38+00 |
Conditional columns
Relationship, Funding ID, and Claims-based Funding Date (marked “Conditional” in the table above) appear only when enabled for your organization. If a conditional column is not enabled for your organization, you will not see it in your report.
Language Note
Our platform refers to individuals within an organization as members. You may also know members as account holders, consumers, employees, or participants.
Accountholder and dependent claims
The Relationship column shows whether the claim belongs to the primary accountholder or one of their dependents. No need to check enrollment separately.
Understanding benefit fields
Benefit Type and Benefit Title describe the same benefit at different levels of detail. Benefit Type is the system code (e.g., DC-FSA or HRA), and Benefit Title is the user-friendly name (e.g., Dependent Care or Healthcare FSA). You may also see Benefit Offering ID referred to as Benefit ID elsewhere in the Health Wallet Manager; these are different terms for the same thing: a unique identifier for a benefit configuration.
Card and manual claims
Each claim is either a card claim or a manual claim. A card claim is tied to a card transaction. A manual claim is submitted for reimbursement of an out-of-pocket expense. This distinction explains a few fields: Merchant Name is populated only for card claims and is blank for manual claims. A card claim may also show a blank Merchant Name if the card network did not include merchant data in the transaction.
Understanding claim statuses
The report uses the following claim statuses. The exact value as it appears in your export is shown in parentheses.
Claim status | What it means |
Pending (PENDING) | The claim is awaiting evidence or has not yet been reviewed. This is the starting status. |
In Review (IN_REVIEW) | The claims team is actively reviewing the claim. |
Information Requested (INFORMATION_REQUESTED) | More information is needed before the claim can be processed. |
Resubmitted (RESUBMITTED) | The member edited and resubmitted the claim, which returns it to review. |
Approved (APPROVED) | The claim has been approved. This status is brief, because approval starts payment right away. |
Payment Pending (PAYMENT_PENDING) | The claim is approved and payment is in progress. |
In Accrual (IN_ACCRUAL) | Funds are accruing before payment. Applies to accrual-funded benefits only. |
Paid (PAID) | The claim has been approved and payment has been completed. |
Rejected (REJECTED) | The claim was denied. This is the status behind the Claim Denied Date column. |
Out of Pocket (OUT_OF_POCKET) | An approved claim that hasn’t been paid because the member hasn’t met their out-of-pocket threshold yet. |
Cancelled (CANCELLED) | Defined in the system but not currently in use. |
A note on common statuses
Because some statuses are brief, you’ll see some far more often than others. “Pending,” “In Review,” “Information Requested,” and “Paid” are common. “Approved” is rarely seen because approving a claim starts payment right away, and the claim moves to “Payment Pending” almost immediately. You may see “Payment Pending” during the window between approval and finalization, since payment settles on a regular processing cycle.
Approved Amount and Out-of-Pocket Claims
For HRA plans with tiered reimbursement, “Approved Amount” reflects what’s eligible for reimbursement, not what the member was actually paid. A fully approved claim can still result in $0 being paid, with the status shown as “Out of Pocket.” “Claim Status” is the only signal of payment for these claims in this report, and even a “Paid” status doesn’t guarantee the full approved amount was paid.
Claim status dates
The report includes a date column for several statuses: Claim in Review Date, Claim Pending Date, Claim Denied Date, and Claim Approved Date.
Current status only
These columns reflect the claim’s current status only, not its history. Each date is shown only while the claim is currently in that status. For example, a claim that moved from pending to approved shows a date in Claim Approved Date but a blank Claim Pending Date. The date columns do not track past status changes
How members see claim status
Members see a slightly different set of labels in the Health Wallet, including “Partially Approved” and “Partially Paid.” These labels are not separate statuses in the report. They are based on the amounts:
A member sees “Partially Approved” when the approved amount is less than the submitted amount.
A member sees “Partially Paid” when a paid claim’s amount is less than the submitted amount.
In this report, these claims appear under their underlying status (e.g., “Paid”). Comparing the Submitted Amount and Approved Amount columns reveals the “Partially Approved” detail. The “Partially Paid” detail is not currently visible in this report, since the amount paid is not included as a column.
For HRA plans with tiered reimbursement, this comparison doesn’t fully apply. “Approved Amount” doesn’t reflect what was actually paid. See Approved Amount and Out-of-Pocket claims above for details.
Report selections reflected
The claims report reflects the selections you make when generating it. You can run it for all applicable benefit types or for a single benefit type. Note that HSA is not included in this report. Check the parameters when generating a report to ensure the results reflect what you need.