Auto-Adjudication for PayFlex Card Transactions

PayFlex receives claim files from Anthem, Aetna, and Delta which often allow them to accept PayFlex health FSA card transactions without needing any additional documentation.  This applies to standard copayment amounts and coinsurance amounts where the out-of-pocket cost and date of service reported on the file matches the card transaction.  However, if the amount or date of service doesn’t match, you will be asked for additional documentation.  If PayFlex requests additional documentation, you must provide it within the required timeframe to avoid the reclassification of your card transaction to taxable income and the suspension or declination of your card as required by the IRS. There were some initial file challenges during the implementation process, but they are now running smoothly and claims are being matched for auto-adjudication.

Keep in mind that PayFlex typically auto-adjudicates over 90% of their card transactions!   Flexible Spending Account Sourcebook is located at

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