Administrative APIs | REST

A unique identifier used to identify your admin instance. This value was system generated with the admin instance was created.

Unique identifier for the employer. Note: When the employer was created, WealthCare Admin assigned the 3-character prefix; you assigned the remaining characters.

Unique identifier for the employee.

ID of the dependent as it appears in WCA, if this claim is for a dependent.

External Claim Number added to transactions to facilitate and track overpayments. This is something the admin creates.

The claim line number submitted with the claim by the insurance carrier.

Determines if this is a crossover claim.

Service start date, when the services began.

Service end date, when the services ended.

Service category code as it appears in WCA.

CPT, HCPCS or other service procedure type. This information is stored in the system for display to the administrator and participant. It is not used by the system to determine whether a claim is eligible.

This is the amount that the provider billed for the service and is only used for display only; no system business rules are performed using this amount.

This is either the network contracted amount (in-network) or the usual and customary rate (Out-of-network) for the service provided to the participant; only used for display; no system business rules are performed using this amount.

This is the amount that the insurance provide paid of the billed amount for the service and is only used for display; no system business rules are performed using this amount.

If provided, this amount will be used as the participant's deductible responsibility.

If provided, this amount will be used as the participant's Coinsurance responsibility.

If provided, this amount will be used as the participant's Copay responsibility.

Amount that would otherwise be covered but has been denied by the carrier due to a benefit maximum being met.

If provided, this amount will be used as the participant's Excess Amount responsibility.

Amount denied as not covered by the insurance plan; typically, this amount will match the Billed Amount.

The amount above the usual and customary rate.

Required to pay Providers. Only if the employer is enabled for provider pay, the service category is enabled for pay provider, and the provider ID is setup in WCA will the claim be paid to the provider.

The Provider Name as it will appear in WCA on the new claim entry page, as well as on all reimbursements and associated communications. Ok to pass blank if Rx/OON and payment could never go to member.

The Service Category Tier must be setup within the Service Category for this field to successfully process. Must match a Service Category tier setup in the WealthCare Administration system for a claim to be successfully processed.

You can assign and use a number to identify specific claims. Note: WCA does not use this number for claims matching purposes.

The record tracking number is used to identify line numbers within an import record. If this field is sent during import, WCA will return these values in the result file.

Enter any comment relevant to the claim line.

The date the claim was received by the carrier - not the date is was adjudicated.

Indicates if a denial letter should be generated for the claim.

Indicates if the notes should be included in the manual claim letter.

ID of the participant the claim relates to.

The external claim ID.

Claim line for which the reimbursement information is being provided.

Amount of the transaction that was approved.

Details the amounts paid for each plan type for the claim line in total, such as: FSA:100.00|HRA:20.00

This is the amount deducted from the Approved Amount as a result of ineligible card (POS) transaction offsetting.

Details the balances in each affected account AFTER the transaction: FSA:100.00|HRA:20.00

Response or error code in detail.

The total amount to be paid by the external system for this claim. For example, an employer can be configured to have HRA payments made by an external system (i.e., external reimbursement method) and FSA payments.

Details the amount by account type being reimbursed through an external reimbursement method: FSA:100.00|HRA:20.

Record Tracking Number sent on the incoming record.

Number you assign to track claims. Note: WCA does not use this number.

Details the amounts paid for each plan type for the claim line's coinsurance amount, such as: FSA:100.00|HRA:20.

Details the amounts paid for each plan type for the claim line's coinsurance amount, such as: FSA:100.00|HRA:20 .

Details the amounts paid for each plan type for the claim line's copay amount, such as: FSA:100.00|HRA:20.

Details the amounts paid for each plan type for the claim line's Excess amount, such as: FSA:100.00|HRA:20

Details the amounts paid for each plan type for the claim line's Benefit Max Met amount, such as: FSA:100.00|HRA:20

Details the amounts paid for each plan type for the claim line's Not Covered amount, such as: FSA:100.00|HRA:20

Details the amounts paid for each plan type for the claim line's Above UCR amount, such as: FSA|100.00|HRA|20.00

The reason why an amount cannot be reimbursed from an account or why an account reimbursement amount has been reduced.

Description of the error that occurred.