Administering Flexible Spending Accounts

This chapter provides an overview of Flexible Spending Account (FSA) Administration, lists common elements, and discusses how to:

• (USA) Enter health care claims.

• (CAN) Enter claims.

• Process FSA claim payments.

• View claim and payment details.

• Reverse checks and claims.

• Report and close FSAs.

Understanding FSA Administration

This section discusses:

• Payment processing.

• FSA Administration processes.

Payment Processing

Payment processing is based on the one or more benefit programs that you group together and the plan year that you identify. You can run payment cycles simultaneously. Scheduling frequent payment processing is to your advantage because employee year-to-date information remains current.

FSA Administration Processes

This table lists the FSA Administration processes:

Common Elements Used in This Chapter

(USA) Entering Healthcare Claims

This section provides an overview of claims processing and discusses how to enter healthcare claim data.

Understanding Claims Processing

FSA Administration starts with your receipt of employee claims. As employees submit claims, you use specific healthcare and dependent care pages to enter data. Continue entering data and making changes until you’re ready to process payments.

When submitting a claim, the system can allow a 2 1/2 month grace period. This allows employees to submit claims for services that occurred 2 1/2 months after the end of the plan year. Whether this grace period is allowed is determined by the dates entered in the FSA Service From Date and Through fields on the FSA Admin Config page.

Employees can be enrolled in two FSA plans that have overlapping service dates. So if a claim is submitted that falls within the service dates of two plans, the system selects the older plan and checks whether there is an amount available for reimbursement.

• If there is no money available for reimbursement in the older plan, the claim is paid using the later plan.

• If there is money available for reimbursement in the older plan and the amount available can cover the entire claim, the claim is paid using the older plan.

• If there is money available for reimbursement and the amount available cannot cover the entire claim, the claim is paid using both plans.

• If the money available in both plans is less than the submitted claim, the claim is paid using the amount available in both plans and the remaining submitted amount is denied.

Before you process a payment, make changes to claim data on participant pages. You use the participant pages to locate claim and payment data, using a variety of search criteria.

Pages Used to Enter Healthcare Claims

Entering Healthcare Claim Data

Access the FSA Claims Entry page.

For terminated employees, you can enter claims through the end of the plan year and process claims up to the full annual pledge elected.

Claim Details

(CAN) Entering Claims

This section provides an overview of claims processing and discusses how to enter claim data.

Understanding Claims Processing

Canadian employers use the Canadian Health Care and Canadian Retirement Counseling Data Entry pages. Canadian pages operate much like the U.S. pages described in the preceding sections. There are additional Canadian data entry pages to allow for multiple line items per claim.

Pages Used to Enter Claims

Entering Claim Data

Access the Claim Data Entry page.

Service From and Service To	These dates represent the earliest and latest entries of the detail line items. When you finish entering these dates, access the Health Care Claims Entry page.
Total Amt Billed (total amount billed)	Enter an amount for each claim line item.
Patient Code	If the claim is for an employee, enter Employee. Other values are Dependent, Spouse, and [None]. If the relationship is Dependent or Spouse, enter the name of the related person.

Revenue Canada requires that Canadian Retirement Counseling claims be paid directly to the service provider, not the claimant. For this reason, the Canadian Retirement Counseling page requires the entry of a provider ID. This provider information appears on the check stubs for the claimant, along with employee claim information. Special care is required in situations that involve partial payments.

Processing FSA Claim Payments

This section provides an overview of payment cycle activities and discusses how to:

• Print checks.

• Print the check register.

Understanding Payment Cycle Activities

For each payment cycle, perform these activities:

1. Set up a run control ID for the payment processing cycle.

2. Initiate the FSA Claims Processing process.

3. To process claims payments, initiate FSA Claims Processing from the Process menu.

The system then does the following:

1. Based on the run control ID that you set up, processes all claim data with statuses of Submitted, Pending, or Ready To Pay.

2. During payment processing, verifies that claims approved year-to-date do not exceed the annual pledge amount for the healthcare account or the year-to-date contribution for the dependent care account.

3. Based on the minimum check amount that you define for employees in a benefit program, holds claims that are less than the minimum, changing the claim status to Pending.

   The system processes the claim but does not print a check until the total of the pending minimum reaches the minimum check amount. You define the minimum check amount for participants in a benefit program on the Benefit/Deduction Program page.

4. When the total for pending claims reaches the minimum, during the next processing cycle the system processes a payment for the employee.

5. Holds dependent care claims that are more than the year-to-date contribution amount.

   For example, if an employee submits a dependent care claim for more than the amount contributed to the dependent care FSA as of that date, the system pays the claim up to the amount in the FSA and holds the excess in a pending status.

6. After processing a claim, changes the claim status from Submitted to Pending, Ready to Pay, or Fully Processed.

Pages Used to Process FSA Claim Payments

See Also

Enterprise PeopleTools PeopleBook: PeopleSoft Process Scheduler

Printing Checks

Access the FSA Check Printing page.

To print checks, set up and run the Check Print process using the Reports menu. This process prints checks for all of the claims with statuses of Pay this Run and form IDs that are equal to the form ID defined on the FSA Check Printing page.

The Check Print process also updates the claim payment status from Pay this Run to Paid.

Printing the Check Register

Access the FSA Check Register page.

To print the FSA Check Register, initiate the Check Register process. There is one check register for each benefit plan year, sorted by the healthcare and dependent care claims.

See Also

Benefits Administration Reports

Viewing Claim and Payment Details

This section provides an overview of claim and payment details and discusses how to:

• (CAN) View FSA claim information.

• View payment details.

• View year-to-date employee data.

Understanding Claim and Payment Details

Claim detail refers to specific claims. Payment detail refers to specific payments an employee receives during a plan year. Year-to-date activity refers to total pledge, contribution, claim, and payment amounts.

Use the FSA Claim Review page to view claim detail for any claim. You locate a claim by entering one or more search criteria.

To request a search based on FSA claim status, enter one of these codes: F (fully processed), J (rejected), P (pending), R (ready to pay), S (submitted), or X (reversed).

Note. (CAN) Canadian users can review two levels of claim details. Both U.S. and Canadian users review claims at the first level of claim details, the FSA Claim Review page. Canadian users use the Health Care Participant - Claim Details page to review further details about healthcare and retirement counseling claims.

Pages Used to View Claim and Payment Details

(CAN) Viewing FSA Claim Information

Access the FSA Claim Entry (CAN) page.

Claim Details	This group box contains various claim amounts, such as amounts approved and denied.
Claim Payments	This group box provides payment information for this claim. Note that you might see more than one check for the same claim. This can happen in a situation where the system held part of a claim and then paid it after funds became available.
Status	When you enter claim data, the system sets the claim status to Submitted. When the system approves payment for a claim, it sets the status to Ready to Pay, Pending, or Fully Processed.

Viewing Payment Details

Access the FSA Payment Details page.

Paymt Stat (payment status)

The system displays one of these values: Pay This Run: Payment has been calculated and authorized, but a check has not yet been printed. Reversed: Payment was cancelled before a check was printed (although a check number was still allotted). Paid: A check has been printed. Void: A check was printed and subsequently voided.

Reviewing FSA Claims

Access the FSA Claim Review page.

Deduction Begin and Deduction End	Displays the dates on which the first and last deduction can be taken from a participant’s paycheck.
Coverage Begin and Coverage End	Displays the dates on which FSA coverage begins and ends.
Account Status	Displays the current status of the FSA account.
Amount Available	Displays the Annual Pledge Amount minus claims amounts that have been submitted or paid. This may be more than the contributions that the employee has made to date.
Split Claims	Select to split or divide a claim into two with payments paid out of both plans during Claims Processing. Note. A claim may be split if it is eligible to be paid under two different plan years due to overlapping service dates and the submitted amount exceeds the amount available from the first plan year.

Viewing Year-To-Date Employee Data

Access the FSA Year-to-Date Activity page.

FSA Account Status

Update the status of this account. The system maintains this status, but you can update it. You might do this, for example, if you decide to close an account before the end of the year (however, you would typically use the Manage Base Benefits business process to terminate an employee’s FSA election).

Reversing Checks and Claims

This section provides an overview of reversals and discusses how to:

• Reverse erroneous payments.

• Enter claim reversal parameters.

Understanding Reversals

You may have FSA payment checks or claims that were entered erroneously. You handle these situations with processes that reverse offending checks and back out incorrectly entered claims, returning the associated FSA accounts to the state they were in before the checks, claims, or both were entered into the system.

Pages Used to Reverse Checks and Claims

See Also

Enterprise PeopleTools PeopleBook: PeopleSoft Process Scheduler

Reversing Erroneous Payments

Access the FSA Check Reversal Process page.

To set up the FSA Check Reversal process run control ID, enter the Form ID, Check # (check number), Check Dt (check date) for the check that you want to reverse.

If there is claim payment information related to the check that you identify, the system automatically populates fields in the Issued to group box. You can use this information to verify that you specified the correct check.

The FSA account balance (as represented by the highest elected FSA Benefit record for the calendar year) is adjusted to reflect a reduced Paid To Dt field.

Entering Claim Reversal Parameters

Access the FSA Claim Reversal Process page.

Use this page to identify the FSA claim that you want to reverse by entering the employee ID, plan type, and claim ID associated with the claim. The system populates the Claim Reversal Details group box when an existing claim is identified. It lists all checks that reimbursed portions of the claim specified. Each of those checks must be reversed before the specified claim as a whole is reversed. The Claim Reversal process performs this step.

The system populates the Add’l Claims which will be affected (additional claims which will be affected) group box when an existing claim is identified. It lists all FSA claims that are affected when the checks listed in the Claim Reversal Details group box are reversed. Additional claims are held and any reversed amounts are paid during the next run of the FSA process.

When you run the FSA Claim Reversal process, the system reverses the FSA claim, first by reversing every check that reimburses the claim and then by backing out the claim itself. The claim’s Paid-To-Date field is cleared, the claim displays a status of Reversed, and the claim’s submitted and approved amounts are subtracted from the committed FSA account balances.

Note. The committed FSA account balances are taken from the highest elected FSA benefit record for the calendar year.

Reporting and Closing FSAs

This section provides an overview of the reporting process and discusses how to close prior year FSAs.

Understanding the Reporting Process

To prepare quarterly employee statements, initiate the Quarterly Account Register process from the Reports menu. These statements provide employees with important information about their FSA accounts: the annual pledge, contributions, and claims paid.

Employees typically have a grace period after the end of the year to submit claims for the prior year. During the grace period, you can process claims for both the prior and current years. After you complete all prior year processing, you can close the prior year and produce a report of prior-year activity. The report serves as an audit trail.

To perform the closing process, select Account Closure from the Reports menu. This process changes the account status to Closed for every account with a coverage period in the year prior to the date when you initiate the close process.

Note. (CAN) On the Canadian version of the FSA Quarterly Statement page, you can elect to report only high-level claim information or full details (per line item).

See Also

Benefits Administration Reports

Pages Used to Report and Close FSAs

See Also

Enterprise PeopleTools PeopleBook: PeopleSoft Process Scheduler

Closing Prior Year FSAs

Access the FSA Account Closure Process page.

The Account Closure process produces a report of prior year claim activity, including detailed data such as employee pledge amounts, contributions, claims paid year-to-date, amounts forfeited, and excess payments. This process also closes the prior year's flexible spending accounts.

See Also

Setting Up FSA Plans