WEX Playbook

This playbook has been created to provide tips and tactics for how to manage WEX claims effectively. WEX is one of the largest TPAs in the country and, as a result, one of our most common denial administrators.

When navigating denied claims specific to WEX customers, there are categories that cause more friction compared to others. 

When issuing a WEX LMN there are three main points that seem to drive a better success rate. When reviewing a denied claim, look to see if the issued LMN clearly has these three points. If it does not, make the necessary changes to the LMN to display these three points. 

1. Avoid using “see following pages” in the treatment section of the WEX template. Include an actual treatment recommendation.

2. Include the full “Truemed Default Template” on additional pages

3. Include the provider signature on the “Truemed Default Template” pages 

When it comes to the merchant receipt, WEX looks for five pieces of information to be included on the receipt. 

1. Date of Service (purchase date)

2. Provider Name (merchant name) 

3. Patient Name (customer name)

4. Product Name 

5. Product Description
   

When looking at these points, the product name and description are the most commonly flagged issues by WEX. If a product name is an unclear name (ex. Summer Six Pack), this is often a reason for claims to be denied. Additionally, receipts that do not include a product description will be denied. 

• Truemed Generated Receipt: Adjust the receipt details as needed to provide clarity. 

• Non-Truemed Receipt: Direct the customer to contact the merchant. Provide clear examples of what needs to change on the receipt. 

  • Ex. Alert the merchant that a detailed description (ex. Guided exercise classes), is needed for the receipt to be approved by your administrator.