How to File a Claim
- Grace Period
- Online Claims Option
- Health Care Pay Me Back (Paper claim form)
- Health Care Pay My Provider (Online payment)
- EZ Receipts™ Mobile App
- Health Care Proof of Expense
You have a grace period -- ending on April 15 -- to submit paperwork for expenses incurred during the previous calendar year. For example, if you incurred eligible expenses one year, you would have until April 15 of the following year to submit your claim. After April 15, you forfeit any money that was contributed the previous year and was left in your reimbursement accounts. Although you have until April 15 to submit your claims, only expenses from the previous calendar year -- Jan. 1 through Dec. 31 -- are eligible for reimbursement. As an additional reminder, you must be a participant in the plan during the time period when the expenses are incurred in order to claim them for reimbursement.
Please note: The grace period does not apply to the Health Care Card. The Health Care Card can only be used for expenses incurred during the current plan year.
- Log on to your WageWorks account.
- Go to the Health Care tab, select the Online Claim link and follow the instructions to enter the Pay Me Back Claim.
- Once you have entered your claim information, you can print the form and mail or fax it to WageWorks with the receipts, or upload a scanned copy of your receipts to the WageWorks system for online processing.
- Claims will be handled per the standard WageWorks claims processing procedures.
- Participants will receive an email notification when the form is:
- Received without an attachment
- Received and the attachment is over the allowed size or in an invalid format (Note: Valid claim attachments must be no larger than 5MB in size and must be submitted in one of the following formats: .TIFF, .PDF, .JPEG, .BMP, .ZIP*)
*Password protected .ZIP files will not be accepted for processing.
WageWorks claim filing service is called Health Care Pay Me Back. Through the Health Care Pay Me Back service, you can get reimbursed from your Health Care Reimbursement Account for eligible products and services you pay for out of pocket.
How to Use Pay Me Back
- Pay for your eligible products and services as you usually do and save your detailed receipt.
- Complete a Health Care Pay Me Back form. Remember to use the last 4 digits of yoru Duke Unique ID instead of your Social Security Number.
- Fax your form and appropriate proof of expense to 1-877-353-9236.
- Or, mail your form and photocopies of your proof of expense to:
PO Box 14053
Lexington, KY 40511
- Check your claims status online anytime by logging on to your personal account (NetID and password required)
- All claims (including resubmissions) must be received no later than April 15 of the year following the plan year (the "Claim it by" date) displayed on your monthly statement or in your online account to be eligible for reimbursement.
When to Use Pay Me Back
Some expenses are easier to pay for first, and then get reimbursed. For example:
- When your provider requires you to pay before you receive the product or service. Pay for the service as required, and then file your claim after you have received the service.
- The expense is listed as a "Maybe" in the What's Covered list, meaning it requires additional information to get approved.
- You receive a bill from your provider after your health plan pays and your portion is less than $20.
Pay your providers directly from your Health Care Reimbursement Account using Health Care Pay My Provider, an optional way of getting reimbursement.
How to Use Pay My Provider
- Log on to Your Personal Account and enter your Duke NetID and password*
- Click on the "Health Care" tab
- Click "Request Pay My Provider"
- Confirm or enter your contact information
- Enter your provider information
- Enter patient information
- Enter your payment amount
- WageWorks will make the requested payment from your account and mail it directly to your provider
- WageWorks will send you an email each time a requested payment is made
Why Use Pay My Provider
- No claims to file; no need to get reimbursed
- Works like a bill pay service
- Deducts automatically from your Health Care Reimbursement Account
- Most convenient way to pay for most recurring eligible health care services
When to Use Pay My Provider
- Regularly scheduled payments for eligible services such as orthodontic or chiropractic care
- When your doctor or dentist bills you for the amount not covered by your health plan
- To pay an invoice for an eligible service you already received and that expense requires only basic proof of service (see below for Proof of Expense information)
- When you need to make a payment of $20 or more
EZ Receipts™ is a mobile app that conveniently and easily submits health care and dependent care reimbursement claims to WageWorks. Install the free App from the iTunes Store, Android Market, or Blackberry App World. Each screen will show step-by-step instructions.
Health Care Card Receipts
Take care of your unverified Card transactions on your time, at your convenience.
- Spend with the Health Care Card
- Launch The App
- Enter Date of card transaction
- Enter Amount of card transaction
- Take Photos - Take or select any number of photographs of detailed receipt (& prescription, if OTC medicine purchase)*
- Submit - whenever the Internet is available and the App is open, the information is sent**
*Photos may be viewed and retaken if needed.
**If there is no internet access, the app will wait to submit the next time the app is open and there is internet access.
The App includes FAQs related to good receipts, good photos, next steps, etc.
- Use proactively to eliminate CUV Requests
- Use diligently to eliminate risk that a Participant (or a family member) may lose a receipt needed for verification
- Use soon after the transaction to prevent CUV requests, or later in response to a CUV request
- WageWorks matches the receipt with the card transaction to verify the eligibility of the expense
You can pay for eligible expenses that require BASIC proof using Pay My Provider or Pay Me Back. For expenses requiring more than BASIC proof (those identified as "Maybe" in the list of eligible expenses), you will need to use an alternate payment method and then file a Pay Me Back claim - along with the required additional information - to get reimbursed.
BASIC (documentation which must be submitted with all claims)
You must provide proof for each expense listed on your Pay Me Back claim form. Your proof should be appropriate for the type of expense:
- Pharmacy receipt for prescriptions and other pharmacy purchases
- Doctor's receipt for office visit
- Explanation of Benefits (EOB) from your insurance or health plan, for covered medical and dental expenses
- Bill or invoice from doctor or dentist for expenses not covered by your insurance or health plan
- Payment contract, monthly payment coupon or statement from your orthodontist
- Receipt from your optometrist or other medical service provider
BASIC + (documentation required for all claims listed as "Maybe"
In addition to the above documentation, a written statement from your provider is required for covered services listed as "Maybe" on the What's Covered page. The written statement must indicate the diagnosis and the medical necessity of the product or service.