They only know the payment didn’t work.

North America’s digital health market was over $182 billion in 2025 and is surging. Today’s patients act like online shoppers. They expect the same type of convenience from their healthcare providers as they do DoorDash. In this landscape, payments aren’t just transactions; they directly impact patient satisfaction, operational efficiency, cash flow, and compliance. 

The HSA/FSA payment challenge  

Health Savings Account (HSA) and Flexible Spending Account (FSA) cards require special tax-eligibility data for each item purchased. Missing this data is the most common cause of HSA/FSA declines. By default, only medical MCCs (doctor’s offices, clinics, and pharmacies) can accept these cards without extra steps. Other retailers must comply via:  

• IIAS (Inventory Information Approval System): A point-of-sale system that tags each healthcare-eligible item. If a merchant has a certified IIAS, that data can be sent with each transaction for automatic approval.  
• IRS 90% Rule: Merchants where >90% of sales are for healthcare items automatically qualify for an IRS exemption. In practice, this lets pharmacies and wellness stores accept HSA/FSA cards without a full IIAS.  

Without one of these measures, potentially eligible purchases are simply declined. Additional compliance requirements and multiple merchant categories can make HSA/FSA acceptance complex, often causing revenue leakage for providers selling medical supplies, wellness products, or telehealth subscriptions.

Cartis Payments now supports enhanced HSA/FSA payment processing through the NMI gateway, helping healthcare organizations reduce declines, improve patient payment experiences, and capture more eligible healthcare spend. 

• One unified platform: Online, in-clinic and mobile payments all run through a single integration and dashboard. There’s no need to rebuild gateways or juggle spreadsheets. Reports and compliance scope are centralized.  New sales channels (telemedicine bookings, recurring care plans, etc.) can be added as simple feature enhancements.  
• Built-in HSA/FSA compliance: The system recognizes all healthcare MCCs automatically and processes partner-provided IIAS data. It also auto-detects 90%-compliant merchants and applies the IRS exemption. In short, all required HSA/FSA fields are sent with the transaction so that eligible purchases clear as normal.  
• Fewer declines: With proper eligibility data and merchant configuration, most HSA/FSA cards (which are just Visa/Mastercard debit cards) are approved rather than rejected. This captures more patient spend and reduces billing headaches.  

Benefits for healthcare providers  

The result is a smoother payment experience for patients and a stronger bottom line for providers. Fewer declined transactions mean patients pay instantly and leave with a positive impression, rather than abandoning a purchase. Providers consolidate all sales data (including fees and interchange) in one place, eliminating the manual reconciliation between systems.  Fraud and risk can be managed holistically across channels instead of fragmented by gateway. 

Because the platform is NMI-based, it scales with growing digital healthcare needs. Providers can expand into new verticals (wellness, medical retail, telehealth) without rebuilding payments. Everything stays compliant under one roof. Over time this unified stack even improves cost efficiency (for example by smartly routing transactions through lower-cost debit networks) and gives providers real-time insight into cash flow and operations. 

Cartis + NMI is not just a payments upgrade; it’s a strategic enabler for modern healthcare. 

Let’s review your current payment environment and identify opportunities to reduce declines, improve payment acceptance, and support future growth. 

https://cartispayments.com/contact/