Claims Management


Online claim entry
. For card swipe verification, participants can view transactions in pre-filled and "numbered" online claim forms. For non-card claims, participants enter items into an online claim form. Participant prints an online form and attaches paper receipts before submitting (via fax or mail) to plan service provider.

Claims approval. For online claims, the operator enters the online claim form number and the system populates the screen. The operator checks approved items and clicks okay. Claims are entered in any order, searched for by participant ID, SSN, or online claim form number. An automated rejection letter is printed if claim was a duplicate, incurred outside of the eligibility window, not for a covered expense, or sent in after the grace days.

Electronic claims import. Import claims from carrier or in-house claims-paying systems into WinFlexOne's SQL-based system.

2-½ month FSA rollover. System looks to multiple year balances for available funds. Special "look back" feature compares service dates and adjusts balances when a claim with the prior year's service date is submitted after a current year transaction (manual claim or card swipe) was previously deducted from the rollover balance.

Multiple health care accounts linkages. For example, if HRA and FSA accounts allow the same type of expense, like dental fees, to be paid from either account, the account balance from HRA and FSA are added together for payment approval. The transaction (manual or card) is then deducted from whichever account is flagged to pay first.