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.

Enter the name of the merchant as shown on the claim/receipt. UPDATE: This field is only able to accept the first 22 characters at this time due to a Mastercard/system limitation. Data truncates to only include first 22 characters from the left (right truncated).

The date the claim was received by the administrator

0 (False) - Display transaction in reports 1 (True) – Hide transaction from reports

Enter the account from which the claim is to be deducted from. FSA, DCA, etc

Amount of claim/transaction.

Required if this field is being used as the unique cardholder identifier and card number is not provided. Either this field or Cardholder SSN may be used for this purpose.

Required if this field is being used as the unique cardholder identifier and card number is not provided. Either this field or Cardholder ID may be used for this purpose.

Benefit card number. You must provide either the Card Number or Cardholder Social Security Number or Cardholder ID; all are not required. If either or both of the cardholder identifiers (SSN or ID) are provided in addition to card number, card number is used.

Beginning Date of Services for the transaction. The actual date that the cardholder had the service provided.

Ending Date of Services for the transaction. The actual date that the cardholder had the service provided.

Plan year start date for the plan that the account making the claim is under.

Plan year end date for the plan that the account making the claim is under.

Amount, if any, that is not approved. Approved Claim Amount + Denied portion of Claim = Total Claim

Code set at the administrator level in system for EOB.

Date displayed to the employer/employee. Default to Today’s date unless date is listed.

0 (False) = No 1 (True) = Yes Defaults to true (Yes).

First 3 characters are the employers prefix, unique for each employer. Next 9 characters are created by the administrator for the employer.

Enter the merchant’s identification number

Required if Plan has maximum amounts on individual MTC codes. If required, value must be greater than 0. The value does not need to match any existing MTC.

Specific note to tie to this transaction.

A unique identifier for your administrator instance, generated by WCA when the instance was first set up. If a value is not sent, the TPA ID from the user making the request with be used.

Assigned by the administrator, needed to track export of claim back into the administrator’s system. Tracking number are used in the result file to uniquely identify whether this transaction was processed or not.

Plan ID for the plan that the benefit account is under.

Determines if the participant's eligibility will be checked. 0 (False) 1 (True)

Determines if an on hold transaction will be allowed. If the manual claim is for more than the disbursable balance, then an on-hold transaction is created for the remaining dollar amount. 0 (False) 1 (True)

Determines if the claim will be eligible for POS offset.0 (False) 1 (True) If set to True, and the Employer is setup for Ineligible POS offsetting, then the manual transaction would apply to the balance due, if there is any.

Determines if Suspend Activity status will be overridden. 0 (False) 1 (True) Set to true if overriding a qualified live event that is in Suspended status.

Determines if the claim amount is subject to the deductible. 0 (False) 1 (True) False – apply claim to the deductible where applicable. This is the default behavior. True – bypass the deductible and attempt to reimburse claim regardless of whether the deductible has been met.Field ignored if plan not enabled for deductible management.

Determines if the account's eligibility dates will be enforced. 0 (False) 1 (True) True -  The Service Start Date and Service End Dates must be within the Employee and/or Dependent’s eligibility and termination dates. False – WCA does not enforce Participant Eligibility Dates.

Service Category Code (SCC).

Determines if Manual Claim Denial Letter will be generated. 0 (False) – Do not generate Manual Claim Denial Letter 1 (True) – Generate Manual Claim Denial Letter

Determines if this is a crossover claim. 0 (False) 1 (True)

The amount of the claim that is pended by the administrator.  This amount will not be approved for payment and will be reflected as “Pended Amount” in the system and in claim letters generated by WCA. If using the Manual Claim Letter in WCA, a pending letter will be generated and sent to the participant.

Reason Code associated with Pended Amount (these codes are set up by the admin).

Employee's flex account ID that the transaction is occurring on.

Determines if the claim amount is paid to the provider. 0 (False) – Claim amount is reimbursed to the participant 1 (True) – Claim amount is paid to provider

The provider's patient identification number, to be used for provider payments.

Dependent's ID in WCA. Required if this field is being used as the unique cardholder identifier and card number is not provided. Either this field or Dependent SSN may be used for this purpose. If this was not a dependent transaction, this field can be ignored.

Dependent's social security number. Required if this field is being used as the unique cardholder identifier and card number is not provided. Either this field or Dependent ID may be used for this purpose.  If this was not a dependent transaction, this field can be ignored.

Determines if the card proxy number was provided in the CardNumber field. 0 (False) – Card Number provided in Card Number field 1 (True) – Card Proxy Number provided in Card Number Field

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

Allows administrators to exclude the transactions from WCA Employer Funding calculations. 0 (False) – Include in Employer Funding (Default) 1 (True) – Exclude from Employer Funding

Determines if the claim will be a recurring claim, and what the recurrence is. 0 – None (Default), 1 - Once, 2 - Weekly, 3 - Monthly

The start date for the first recurrence of the claim.  Required if Recurrence value is not set to 0 = None. Start Date must be greater than or equal to today’s date and cannot be more than 18 months in the future.

The end date for the recurrence.  If specified, no claims will be created after this date.  If Recurrence value is not set to 0 = None, then either Recurrence End or Total Number of Payments is required. End Date must be greater than or equal to today’s date and cannot be more than 18 months after the Start Date.

Number of Payments to be made.  If Recurrence value is not set to 0 = None, then either Recurrence End or Total Number of Payments is required. Note 1: For Weekly Recurring Frequency, Total Number Of Payments cannot be more than 75. Note 2: For Monthly Recurring Frequency, Total Number Of Payments cannot be more than 18.

Indicates if the transaction was submitted for pay provider.

The Tracking Number that was used on the SubmitManualClaim.

The original transaction amount.

Error code that the claim received.

The approved amount of the transaction.