What is the Substantiation Process?

Optum Financial will try to contact the participant three times via letter/email to notify them of the request for more information.

The standard timeline for claim follow-up for unsubstantiated claims is:

  • Sixty days after an unsubstantiated claim is received, communication (via email if employee has one on file, letter if not provided) is sent to the employee.
  • Sixty days after the initial communication, a second communication (via mail) is sent to the employee.
  • Forty-five days after the second communication, a third communication (via mail) is sent to the employee. It states that if documentation is not received within 10 days of the date of this final letter, the card will be suspended.
  • Fifteen days after the third communication (180 days after the initial card swipe), cards will be suspended if proper documentation has not been provided.