Dependent Care Account - Claim Filing Instructions - How to File a Claim for Approval

Sep 19, 2026

Upload by Jacob

Dependent Care Account claim instructions for obtaining approval, covering online submission and alternative fax or postal filing to the claims administrator. The form outlines required account-holder details and provider documentation, specifying what information to include for provider name, service dates, dependent relationship, service type, and billed amount. Guidance explains eligibility rules for dependent care expenses, acceptable documentation requirements, and tips for faxing and processing timelines.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

How to File a Claim for Approval

Claim Filing Options

Instructions to Fill Out the Form

Tips for Claim Submission

Tips for Documentation

Tips for Faxing

[www.wageworks.com](www.wageworks.com) DEPENDENT CARE ACCOUNT How to File a Claim for Approval Claim Filing Options: • File claim online: Log into your account at [www.wageworks.com](www.wageworks.com) to submit your claim electronically. • File claim via fax or mail: Claim details may be entered online and a completed form may be printed and faxed or mailed with documentation. Fax: 877-353-9236 , US Mail: CLAIMS ADMINISTRATOR, P. O. Box 14053, Lexington, KY, 40512 Instructions to fill out this form: • Complete ALL account holder information. Please give your employer name without abbreviation. • Use your documentation to complete each section of the form, including the following items: 􀁣 Provider Name 􀁤 Service Date(s) 􀁥 Dependent Name and Relationship to Account Holder 􀁦 Type of Service 􀁧 Amount Billed 􀁨 Provider Signature is not required , but can replace need for other proof of service SM I T H J O H N J O N E S G R A P H I C S 5 4 2 1 1 0 0 6 3 Sunshine Day School 0 0 1 0 3 1 5 1 0 7 1 5 1 1 5 0 0 Martha Sunshine Debbie's Daycare 0 1 0 3 1 5 0 1 0 7 1 5 Mary Smith 1 3 5 0 0 Debbie Johnson Tips For Claim Submission • Dependent care expenses cannot be paid to anyone who is your child or stepchild under the age of 19 and claimed as a dependent on your tax returns. • A dependent is defined as someone who spends at least 8 hours a day in your home and is one of the following: • A tax dependent child under the age of 13 for whom you have custody more than half of the year. • A dependent that is physically or mentally incapable of self care regardless of age. • Only submit claims for eligible expenses. Extended overnight camps, kindergarten or higher-grade tuition, non work related daycare or long-term care services are not eligible expenses. The only expenses considered eligible are those that are incurred while you or your spouse are working, looking for work, or attending school full time. Tips For Documentation • Ensure that the documentation is legible. • Cancelled or copies of checks and credit card receipts do not contain all 5 required pieces of information needed to approve your expense, and are not acceptable for submission. • If multiple pieces of documentation are attached, please circle the dollar amount that is being claimed on each piece of documentation. • The use of a highlighter causes items to not be legible on the documentation; highlighter use is not recommended. • At the end of the tax year, you are required to provide the IRS with the provider name, address and Tax ID \# on Tax Form 2441 in order to obtain the tax advantage for these expenses. Tips For Faxing • Do not use a cover page when faxing the claim form and documentation. • Please allow 2 business days from receipt of your claim for processing. • You will be notified via email of the status of your claim if we have a valid email address on file (to update your email address, please log into your account at [www.wageworks.com](www.wageworks.com) and select “Profile” in the upper right corner of the screen. • Send only photocopies of your claim form and documentation—keep the originals for your records if submitting via postal mail. • Submit only claims for your own account. 3846 (02/2015) DEPENDENT CARE ACCOUNT [www.wageworks.com](www.wageworks.com) • File claim online: Join the growing majority of participants who submit their claim online for faster service. Log into your account at [www.wageworks.com](www.wageworks.com) to file your claim electronically and upload your documentation. • File claim via fax or mail: Claim forms may also be filed either via fax or US Mailand sent to the following locations: Fax: 877-353-9236, US Mail: CLAIMS ADMINISTRATOR, P. O. Box 14053, Lexington, KY, 40512 Pay Me Back Claim Form • Claim processing time: Claims will be processed within 2 business days after receipt of the form. You may check the status of

FAQs

How can a dependent care claim be filed for approval?

A claim can be filed online by logging into the WageWorks account, or submitted via fax or US mail after printing a completed form and including documentation.

What information must be completed when filling out the claim form?

All account holder information must be completed, using documentation for each form section including provider name, service dates, dependent details and relationship, type of service, billed amount, and any needed signature replacement guidance.

Which dependent care expenses are eligible for reimbursement?

Eligible expenses are those incurred while the account holder or spouse is working, looking for work, or attending school full time. Extended overnight camps, kindergarten or higher-grade tuition, non work related daycare, and long-term care services are not eligible.

Sep 19, 2026

Upload by Jacob