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Submit a Flex Claim
| Method |
Claim Submission Instructions |
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For mail, e-mail, and fax submissions, complete the Request
for Reimbursement Form . |
| Mail |
P.O. Box 93148
Des Moines, IA 50393 |
| E-mail |
wellfsa@wellmark.com
Scan your claim form and receipts and e-mail the file. |
| Fax |
(515) 248-5350 |
| Online |
Use the online
flex claim system to enter your claim directly into Wellmark’s
flex system to simplify the processing of your claim. Print the
form and attach receipts to send via one of the above methods.
- If you have not yet registered, select New User and
complete the form to create an account.
- If you're already registered, log in with your user name and
password and select Request
Payment.
- Select the
claim type from the drop-down menu.
- Enter the requested information about the claim.
- Print your completed form
by selecting View Form and Continue.
- Sign and date the form,
and forward it to Wellmark by mail, fax,
or e-mail with your receipts for processing.
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Sign up for direct
deposit (pdf) or automatic
reimbursement (pdf) to speed up
the reimbursement process for medical expenses.
Questions about submitting claims? Call a Wellmark
flexible benefits specialist at (800) 624-2755 or e-mail wellfsa@wellmark.com. Claims Filing Checklist
- Verify the claim form is signed
- Attach a copy of third-party verification for the expense, such as:
- Explanation
of benefits (EOB)
- Provider’s receipt documenting name of patient,
date of service, and amount of the expense
- Pharmacy receipt showing
name of drug or over-the-counter medicine
- Submit copies of your receipts; keep originals for your
records.
- Be sure receipts are
clearly readable.
- Affix small receipts to an 8 ½” x 11” sheet
of paper to keep them with the claim form.
- For dependent care:
Provide receipt listing dates of service, or have your dependent
care provider sign the claim form.
Orthodontia Claims
- Submit copies of receipts for payment/services that have incurred
for current plan year, or
- Complete the Orthodontic
Payment Form to receive
recurring monthly payments
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