Valid Receipt Example

 

mycafeteriaplan bullet imageWhat is a Valid Receipt?

Cafeteria Plans, Flexible Spending Accounts, Health Reimburesement Arrangements and Health Savings accounts are usually pre-tax benefits and are governed by rules issued by the IRS. The IRS says a valid receipt must be produced by your provider and include five specific details about the service you received.

  1. Provider Name
  2. Date of Service
  3.  Patient Name
  4. Service Description
  5. Service Charge

X  Bad Receipt

Receipt 1

 

1. Provider Name: Ed’s Pharmacy

2. Date of Service: 9-15-07

3. Patient Name: Jane Doe

X 4. Service Description: Missing

5. Service Charge: $15.82

 

 Good Receipt

Receipt 2

 

1. Provider Name: Ed’s Pharmacy

2. Date of Service: 9-15-07

3. Patient Name: Jane Doe

4. Service Description: Loratadine

5. Service Charge: $15.82

 

 X Bad Receipt

Receipt 3

1. Provider Name: Sample Dentistry

X 2. Date of Service: Missing

X 3. Patient Name: Missing

X 4. Service Description: Missing

5. Service Charge: $168.00

 

 Good Receipt

Receipt 4

1. Provider Name: Sample Dentistry

2. Date of Service: 9-15-07

3. Patient Name: John Doe

4. Service Description: Extraction

5. Service Charge: $168.00

For a PDF file of this information that you can print and distribute, please click here.