Week 6: How Substantiation Saves (or Costs) You Thousands
Welcome to Week 6 of the Q4 EBA&M Boot Camp.
The Hidden Cost of Poor Substantiation
Most TPAs use a simple rule: if the card goes through, the claim gets reimbursed.
But that shortcut can cost employers thousands in misuse — and create major compliance risk.
EBA&M doesn’t take that shortcut. Our transaction-level substantiation:
Filters out non-eligible charges (including cosmetic, wellness, and luxury retail)
Flags sketchy online vendors and “gray-area” expenses
Ensures every dollar reimbursed is eligible and compliant
Why This Matters for Brokers
When your group overspends on ineligible claims, it:
Drives up future funding needs
Wrecks trust in the program
Can even lead to clawbacks or audit exposure
And worst of all — they might blame you, not the TPA.
What Makes EBA&M Different
Dedicated substantiation team reviewing claims in real time
1
We don’t just auto-approve based on card swipe
2
We use MCC analysis and merchant validation tools to protect the plan
3
Optional: deeper employer customization (e.g., exclude Med Spas, supplements, etc.)
This Week’s Download
📄Substantiation Case Study: How We Saved One Employer $9,600 Includes real data from a client where we denied improper claims that slipped through another vendor the year before.
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