Should you encounter any issues during your upload process, you're always welcome to fax your documentation to BASIC FSA (
) or BASIC HRA (
Please enter your company name below.
What are you submitting?
Verification (paid for items or services using the BASIC debit card)
Have you already filed this claim online through the participant portal?
( This website is
the participant portal. )
You must include a copy of the online claim confirmation or documentation request with your upload. Failure to provide this required information will result in your submission/documentation
If you have any technical issues please visit
Before You Begin...
Do you have all the necessary documentation scanned in an image format ready for upload
(TIFF, TIF, JPG, JPEG, PDF, BMP, PNG, GIF)
? Please make sure you have the necessary documentation for all claims you are entering
Your receipt, service bill, explanation of benefits (EOB), or other documentation must include the following
Date of Service
Description of Service
Service Provider Name
$ Charge Amount
Please note that the best form of documentation is your EOB as it will always contain the above information
Claim Confirmation With Receipt