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.
This section discusses:
Payment processing.
FSA Administration processes.
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.
This table lists the FSA Administration processes:
Process |
Usage |
What the System Does |
FSA Claims Processing (FSA001) |
Process claim payments for the employees in the plan years and the benefit programs that you include. |
Processes claims and updates claim and payment detail and year-to-date activity. After you enter claim data, claim status is Submitted. |
Account Closure (FSA002) |
Close out previous year accounts, after you have processed all claims for the year—probably at the second quarter of the current year. |
Updates all prior year accounts to Closed status and produces a report that accounts for prior-year funds. |
Check Print (FSA003) |
Select a type of check to print. |
Prints checks. |
Check Register (FSA004) |
Define check register information for printing. |
Prints check register. |
Quarterly Account Register (FSA005) |
Define quarterly balance statement information for printing. |
Prints quarterly balance statements. |
FSA Check Reversal (FSA006) |
Reverse paid checks to claims. |
If a claim is processed and the check is not printed, the process sets:
If a claim is processed and the check is printed, the process:
|
FSA Claim Reversal (FSA007) |
Reverse an FSA claim and all checks that reimburse that claim. |
If a claim is not processed, the process sets the claim to Void. If a claim is processed, but the check is not printed, the process:
If a claim is processed and the check is printed, the process:
|
Calendar Year |
Enter the year for which you want to process claims. You can process more than one run ID for different years in the same payment processing cycle. However, each combination of calendar year and run ID must be unique. |
Form ID |
Select the stock that you want to use for check printing in this payment cycle. |
Participant |
An individual employee who participates in an employer benefits plan. For example, if an employee contributes to an employer's tax deferred savings plan, he is considered a participant of that plan. All participants are considered employees, but from plan to plan all employees might not be participants. |
This section provides an overview of claims processing and discusses how to enter health care claim data.
FSA Administration starts with your receipt of employee claims. As employees submit claims, you use specific health care and dependent care pages to enter data. Continue entering data and making changes until you're ready to process payments.
When you submit 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 an amount is available for reimbursement.
If no money is available for reimbursement in the older plan, the claim is paid using the later plan.
If money is 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 money is 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.
Access the Create FSA Claims page (Benefits, Admin Flex Spending Acct US, Submit Claims, Create FSA Claims, Create FSA Claims).
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 ID |
Displays the claim ID. The system can automatically assign the claim ID. When you enter a new claim, the Claim ID field is automatically set to NEW. If you do not change it, the system replaces it with the next available eight-digit claim ID when you save the data. After the system assigns the claim ID to the data entry record, it displays a message with the ID that it assigned. This enables you to record the ID on the employee's paperwork, if required. |
Service From and Service To |
Select the dates on which the eligible expenses occurred. If you enter service dates that are not within the same calendar year, a warning appears. A warning also appears if the service dates are not within the coverage begin and end dates. After you enter the service from date, the system displays the FSA benefit plan data for the employee, including the annual pledge. The data is based on the plan year. |
Action Date |
Displays the date on which the claim was entered. |
Service Type |
Select a service type for this claim from the list of available options. |
Submitted Amount |
Enter the amount submitted on this claim. The system verifies that this amount does not exceed the annual pledge amount. An employee can submit a health care claim amount that is more than the year-to-date contribution. If the submitted amount is more than the annual pledge amount, the system pays up to the annual pledge amount that is available and rejects the rest of the claim. If the submitted amount is more than the year-to-date contribution but less than the annual pledge amount, the system pays the claim. For example, if an employee pledges 1200 USD for the year and submits a claim for 600 USD after contributing only 100 USD, the system pays 600 USD. |
Denied Amount |
Enter the values to deny part of a claim or an entire claim. Use these values to indicate expenses that are not eligible for payment under the flexible spending account. |
Denied Date |
Enter the values to deny part of a claim or an entire claim. Use these values to indicate expenses that are not eligible for flexible spending accounts, based on the Section 125 rules. |
Reason Denied |
Enter the values to deny part of a claim or an entire claim. Use these values to indicate expenses that are not eligible for flexible spending accounts, based on the Section 125 rules. Select from the following values:
|
Approved Amount |
Displays a calculated value, based on the data that you enter. |
Patient Code |
For health care claims only, the Patient Code, Name, and Service Provider fields are optional informational fields and are for your use only. If the claim is for an employee, enter the patient code Employee. Other values are Dependent, Spouse, and [None]. If the patient code value is Dependent or Spouse,enter the name of the related person in the Name field. |
This section provides an overview of claims processing and discusses how to enter claim data.
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. Additional Canadian data entry pages allow for multiple line items per claim.
Page Name |
Definition Name |
Navigation |
Usage |
HC_CANAD_DATA_ENTY |
Benefits, Admin Flex Spending Acct CAN, Submit Claims, Create Health Care Claim, Create Health Care Claim |
Enter a new health care claim and provide details for each claim line item. |
|
HC_CANAD_PARTIC |
Benefits, Admin Flex Spending Acct CAN, Submit Claims, Modify Health Care Claim, Health Care Participant |
Make changes to claim data before you process a payment for a health care claim. |
|
HC_CANAD_PARTIC2 |
Benefits, Admin Flex Spending Acct CAN, Submit Claims, Modify Health Care Claim, Claim Details |
Change detailed information about a particular participant health care claim. |
|
RC_CANAD_DATA_ENTY |
Benefits, Admin Flex Spending Acct CAN, Submit Claims, Create Retiremnt Counsel Claim, Create Retiremnt Counsel Claim |
Enter new retirement claims with a detailed level of information. |
|
RC_CANAD_PARTIC |
Benefits, Admin Flex Spending Acct CAN, Submit Claims, Modify Retiremnt Counsel Claim, Claim/Comments |
Review basic claim and comment information for a specific claim. |
|
RC_CANAD_PARTIC2 |
Benefits, Admin Flex Spending Acc CAN, Submit Claims, Modify Retiremnt Counsel Claim, Claim Details |
Change detailed information about a particular participant retirement counseling claim. |
Access the Create Health Care Claim page (Benefits, Admin Flex Spending Acc CAN, Submit Claims, Create Health Care Claim, Create Health Care Claim).
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.
This section provides an overview of payment cycle activities and discusses how to:
Print checks.
Print the check register.
For each payment cycle, perform these activities:
Set up a run control ID for the payment processing cycle.
Initiate the FSA Claims Processing process.
To process claims payments, initiate FSA Claims Processing from the Process menu.
The system then performs the following steps:
Based on the run control ID that you set up, processes all claim data with statuses of Submitted, Pending, or Ready To Pay.
During payment processing, verifies that claims approved year-to-date do not exceed the annual pledge amount for the health care account or the year-to-date contribution for the dependent care account.
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.
When the total for pending claims reaches the minimum, during the next processing cycle the system processes a payment for the employee.
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.
After processing a claim, changes the claim status from Submitted to Pending, Ready to Pay, or Fully Processed.
Page Name |
Definition Name |
Navigation |
Usage |
RUNCTL_FSA_CLAIMS |
|
Set up the information that controls a payment processing cycle. Claims for all employees in the benefit program who are associated with the run ID and a service from date in the calendar year must have a claim status of Submitted or Pending. |
|
PRCSRUNCNTL |
|
Process all claim data with statuses of Submitted, Pending, or Ready To Pay. |
|
RUNCTL_FSA003CN RUNCTL_FORM_ID |
|
Print FSA claim checks for records flagged in FSA001. |
|
RUNCTL_FSA004CN RUNCTL_FSA004 |
|
Print a list of the checks printed on the FSA Check Print Report. |
See Also
PeopleTools 8.52: Process Scheduler PeopleBook
Access the Print Check Register 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 Print Checks or Print Cheques page.
The Check Print process also updates the claim payment status from Pay this Run to Paid.
Access the Print Check Register page.
To print the Print Check Register, initiate the Check Register process. One check register exists for each benefit plan year, sorted by the health care and dependent care claims.
See Also
Benefits Administration Reports
This section provides an overview of claim and payment details and discusses how to:
(CAN) View FSA claim information.
View payment details.
Review FSA claims.
View year-to-date employee data.
Claim detail refers to specific claims. Payment detail refers to specific payments that an employee receives during a plan year. Year-to-date activity refers to total pledge, contribution, claim, and payment amounts.
Use the FSA Claim Details 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 Details page. Canadian users use the Health Care Participant - Claim Details page to review further details about health care and retirement counseling claims.
Page Name |
Definition Name |
Navigation |
Usage |
FSA_CLAIM_DETAILS FSA_CLAIM_DET_CAN |
|
View FSA claim entry information for Canada and the U.S. (on separate pages). |
|
FSA_PAYMENT_DETAIL |
|
View payment detail for Canada and the U.S. for any claim payment. |
|
FSA_YTD_ACTIVITY |
|
View all year-to-date data for Canada and the U.S. for an employee. |
Access the FSA Claim Details (CAN) page (Benefits, Admin Flex Spending Acct CAN, Review Claim/Payment Info, FSA Claim Details, FSA Claim Details).Select the FSA Claim Details tab
Claim Details |
This group box contains various claim amounts, such as amounts approved and denied. |
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. |
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 in which the system held part of a claim and then paid it after funds became available. |
Access the FSA Payment Details page (Benefits, Admin Flex Spending Acct CAN, Review Claim/Payment Info, FSA Payment Details, FSA Payment Details).
Paymt Stat (payment status) |
The system displays one of these values:
|
Access the FSA Claim Details page (Benefits, Admin Flex Spending Acct CAN, Review Claim Payment Info, FSA Claim Details, FSA Claim Details).
Deduction Begin and Deduction End |
Displays the dates on which the first and last deductions 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 can 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 can 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. |
Access the Year-to-Date Activity page (Benefits, Admin Flex Spending Acct CAN, Review Claim/Payment Info, Year-to-Date Activity, Year-to-Date Activity).
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). |
This section provides an overview of reversals and discusses how to:
Reverse erroneous payments.
Enter claim reversal parameters.
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.
Page Name |
Definition Name |
Navigation |
Usage |
RUNCTL_FSA006 |
|
Reverse FSA payment checks that were created in error. |
|
RUNCTL_FSA007 |
|
Enter the parameters for canceling a claim. |
See Also
PeopleTools 8.52: Process Scheduler PeopleBook
Access the Reverse Cheques in Error page (Benefits, Admin Flex Spending Acct CAN, Correct Errors, Reverse Cheques in Error, Reverse Cheques in Error).
To set up the FSA Check Reversal process run control ID, enter the form ID, Check number, and check date for the check that you want to reverse.
If claim payment information is 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.
Claim ID |
Displays the claim paid by the specified check. |
Service From and Service To |
Displays the dates on which the eligible expenses occurred. |
Submitted Amt (submitted amount) |
Displays the amount submitted on this claim. The submitted amount can exceed the annual pledge; it just won't pay the whole amount. |
Aprvd Amt (approved amount) |
Displays the amount of the claim that was approved for payment. The system verified that the approved amount does not exceed the annual pledge amount. |
Paid To Dt (paid to date) |
Displays the amount paid to date for a claim. The FSA Check Reversal process reverses an FSA check by distributing the reimbursement amount back to each of the claims that were paid by the check. For each claim, the value in this field is reduced by the amount paid in the reversed check. |
Amount Pd (amount paid) |
Displays the amount paid for the claim. |
Status |
Displays the claim status. The claim's status is reset to Pending so that it will be picked up during the next FSA Processing run. The check's status is set to Reversed if it has not yet been printed or to Void if it has been printed. |
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.
Access the Cancel Claim/Reverse Cheque page (Benefits, Admin Flex Spending Acct CAN, Correct Errors, Cancel Claim/Reverse Cheque, Cancel Claim/Reverse Cheque).
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.
Serv From (service from) and To |
Display dates that provide information to verify that the correct claim was specified. |
Claim Status and For |
Display additional information to verify that the correct claim was specified. |
When you run the Cancel Claim/Reverse Check 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 deselected, 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.
This section provides an overview of the reporting process and discusses how to close prior year FSAs.
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 Quarterly Account Statements page, you can elect to report only high-level claim information or full details (per line item).
See Also
Benefits Administration Reports
Page Name |
Definition Name |
Navigation |
Usage |
RUNCTL_FSA002 |
|
Close the prior year FSA accounts and produce the Account Closure Statement. |
|
PRCSRUNCNTL |
|
Process quarterly account statements for employees. |
See Also
PeopleTools 8.52: Process Scheduler PeopleBook
Access the Close and Summarize Accounts page (Benefits, Admin Flex Spending Acct CAN, Create Account Reports, Close and Summarize Accounts, Close and Summarize Accounts).
The Close and Summarize Accounts 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.
Pre-Closure report only (do not close FSA accounts) |
Select if you do not want to close FSA accounts. If you run the Close and Summarize Accounts process with this option selected, the system generates a pre-closure report and leaves the FSA Account Status unchanged. This enables you to run the report at any time and get a preview of the company's overall FSA program status. |
Close and Report all FSA accounts for Plan Year |
Select to close all prior-year accounts permanently. |
See Also