How to Ensure Approval When Submitting or Resubmitting HRA Claims for Dental Expenses
Submitting or resubmitting claims for dental expenses under your Health Reimbursement Arrangement (HRA) can often be complex. To ensure approval and minimize rejections, you need to adhere to specific guidelines for documentation. This article lays out the key steps and requirements for claim submissions, potential reasons for claim denial, and how to avoid these issues in resubmissions.
1. Eligible Dental Expenses Covered by HRA
Dental treatments, such as a crown procedure, may qualify as reimbursable medical expenses provided, they are medically necessary and not cosmetic. It is crucial to review the list of reimbursable expenses specific to your plan and follow your benefits administrator's official guidance.
For medically necessary dental procedures like crowns, a Letter of Medical Necessity is typically not required unless specified by your provider’s rules. Receipts containing the required documentation elements are generally sufficient.
2. General Documentation Requirements for Claim Approval
To ensure that your HRA claim is approved, your documentation must clearly include these elements:
Patient’s Name: Who received the service.
Provider’s Name and Address: Name and location of the dental care provider.
Date of Service: When the dental procedure occurred.
Description of the Service/Procedure: A detailed outline of the procedure performed (e.g., periodontal scaling, dental crown fitting).
Amount Paid: Your out-of-pocket expenses.
Proof of Payment: This can include a "Paid" stamp, a zero-balance statement, or an indication of the payment method.
3. Avoiding Common Reasons for Claim Denial
Claims are frequently denied due to incomplete or incorrect documentation. Here are some common pitfalls and how to avoid them:
Missing required information on the receipt or invoice (e.g., lack of patient name or the service description).
Documentation must be recent (dated within 30 days for compliance) and include sufficient detail about the service performed (e.g., stating “dental work” is not acceptable). Corrective steps include confirming inclusion of a detailed, itemized receipt.
4. Steps for Resubmission with Corrected Documentation
If your claim is denied, you can resubmit it with updated and accurate documentation:
Review your initial submission thoroughly to identify missing or incomplete information.
Ensure the resubmitted claim includes: - Patient’s name - Dental provider’s name and address - Service date(s) - Detailed descriptions of the dental services performed - Actual amount paid and proof of payment (e.g., "Paid" receipt or zero balance statement found on the bill).
Submit the corrected documentation via your HRA member portal using the "Add Expense" flow.
5. Tips for a Successful Claim Experience
Always consult your plan’s specific guidelines for a list of reimbursable dental (and medical) costs and necessary documentation requirements.
For broader compliance, include all possible documentation, even if not explicitly stated.
Avoid submitting claims for cosmetic procedures as these are often excluded under HRA plans unless otherwise noted.
By following these comprehensive steps, you can streamline the submission process and maximize your reimbursement success.