Conexis reimbursement form 2026

1. Click ‘Get Form’ to open the conexis reimbursement form in the editor.
2. Begin by filling out the Employee Information section. Include your employer name, employee name, account number or SSN, street address, daytime phone number, city, state, and zip code.
3. In the Claim Information section, provide details such as patient name, date of service, type of service, and total amount requested. If necessary, continue on an additional page.
4. Check the appropriate box in the Supporting Documentation section and attach acceptable documentation. Ensure that receipts are clear and include all required information as outlined in the instructions.
5. Sign and date the Employee Certification to confirm that all information is accurate and complies with your employer’s Flexible Benefits Plan.
6. Submit your completed form by faxing it to (888) 866-3312 or mailing it to P.O. Box 227197, Dallas, TX 75222.

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