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Medical Services Payment Guide

This guide provides information on how to request a payment or reimbursement for medical services incurred as a result of a referral from the Health Center, after-hours emergency, or a required physical examination.

The campus may pay for medical services that are provided by a vendor when the services cannot be provided by the Health Center or are not covered by insurance. Please contact the FAST/AP Help line at 459-4488 with questions or locate your representative directly.​​​

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  • Before you start

    Important information to know:

    • Special conditions: The following special conditions apply to this type of transaction.
      • Examples of medical services that may not be fully covered by insurance include the following:
        • Referrals from the Health Center
        • After-hours emergencies
        • Required physical examinations
    • Avoid conflicts of interest: Refer to the appendices for information covering employee-vendor conflict of interest issues.
    • Tax information: Payments may only be made to recipients with a Social Security Number or an Individual Taxpayer Identification Number (ITIN). Use IRS Form W-7 Application for IRS Individual Taxpayer Identification Number to apply for an ITIN number.
    • Payment: If this is the first time the recipient will be receiving a UCSC non-payroll payment, complete a Payee Setup 204 form.


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  • Ways to pay

    This type of expense is procured by requesting a payment to be made by completing and submitting a Direct Payment form.

    • The Campus Purchasing Card cannot be used to procure this good or service.
    • Out-of-pocket payment for this type of good or service will not be reimbursed.
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  • Requesting a direct payment

    Follow these steps to request a direct payment:

    • If this is the first time the recipient will be receiving a UCSC non-payroll payment, complete a Payee Setup 204 form.
    • Complete a Direct Payment form and obtain approval from an authorized expense approver.
      • Attach supporting documentation, such as original receipts. Refer to the “Receipt and Documentation” topic for more information
    • Submit the Direct Payment form to the divisional or departmental business office for review and “second-tier” approval.
    • The divisional or departmental business office will submit the form and supporting documentation to the Financial Administrative Services and Transactions/Accounts Payable Office (AP) for processing.
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  • Receipt and documentation requirements

    The following supporting documentation must be submitted with a completed Direct Payment form.

    Receipt: Submit all original vendor contracts, invoices, and itemized receipts.

    • An electronic receipt is acceptable as long as it provides the detail needed to substantiate the expense.
    • Photocopies of receipts are not an acceptable substitute for original receipts

    For any items with missing receipts, follow these steps:

    1. Obtain a duplicate receipt from the vendor.
    2. If a duplicate receipt cannot be obtained from the vendor, perform the following steps
      • Submit a statement with the Direct Payment form explaining why the receipt was not provided and including a certification that the expense amount claimed is the amount actually paid to the vendor.
      • Obtain approval on the Direct Payment from a campus officer authorized to approve exceptions to policy. Refer to the appendices for a list of campus officers authorized to approve policy exceptions.
      • Depending on the expense involved, you may be asked to provide additional information by your divisional business office.
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  • Authorization and approval

    Only an individual with written delegated authority provided on the Signature Authorization Approval Form may approve the payment.

    An employee having delegated authority may not approve his or her own reimbursement or payment request.


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  • Applicable tax withholding and reporting

    Payments made directly to a medical service provider are subject to tax reporting (Income type “MD”)

    Refer to the appendices for general tax withholding and reporting information.


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  • Common oversights

    Speed up the payment process by avoiding these common oversights.

    • Forgetting to provide the last four digits of the recipient’s social security number or Individual Taxpayer Identification Number on the Direct Payment form.
    • Forgetting to obtain the appropriate approvals on the Direct Payment form.
    • Forgetting to attach required supporting documentation to the Direct Payment form.
    • Forgetting to submit a Payee Setup 204 form for a first-time reimbursement or payment recipient.
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  • Where to get help

    Assistance is available for the following topics:

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  • Relevant Appendices



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