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What documentation is needed for FSA reimbursement?
For office visits: Your health plans Explanation of Benefits (EOB) statement or an itemized receipt or bill from the provider that includes the patients name, a description of the service, the original date of service and your portion of the charge.
What documentation is required for FSA reimbursement?
The service documentation will need to include: Provider Name Service Dates (not payment date) Patient Name Type of Service Out- of-Pocket Cost or Your provider may sign the form confirming the date of services, charges and other service or product information in lieu of providing separate documentation or
How do I get reimbursed from my FSA?
Regular Reimbursement Requests For non-travel reimbursements, documentation must include a copy of the final invoice or receipt rendered by the vendor at the time of purchase. Invoices and receipts must be properly itemizedlump sum totals for multiple different items on a single receipt are not acceptable.
What needs to be on receipt for FSA reimbursement?
Date of Service: The date on which services were provided or the item was purchased. Type of Service: A detailed description of the service provided or item purchased. Cost: The amount you paid for the service or product and/or the portion that is not reimbursed through your insurance carrier.
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Government at sales@sog.unc.edu or call 919.966.4119. Page 21. Rule 9(j) -- 21. NORTH CAROLINA SUPERIOR COURT JUDGES BENCHBOOK. UNC School of Government.
2014 Oklahoma Resident Individual Income Tax Forms
You must complete your federal income tax return before begin- ning your Oklahoma income tax return. You will use the information entered on your federal return
Item Number 4119. OTHER OPERATING INCOME. Call confidentiality applies to FFIEC 031/041. Series, Start Date, End Date, Confidential? Reporting Forms SVGM4119
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