Participant APIs | REST

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Get Account Service Categories

https://api.wealthcare.com/participant/services/participant/accounts/servicecategories/{tpaId}/{employerId}/{participantId}/{flexAcctId}

The Get Account Service Categories API is used to retrieve the accepted Merchant Category and Service Category Codes accepted on all Service Categories associated to a particular benefit account. The results can be used to determine which merchant or services the benefit account's funds can be used for. The Get Account Service Categories API also returns the spending restrictions rules set on each Service Category associated with the benefit account's plan.

  • tpaId string Required

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

  • employerId string Required

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

  • participantId string Required

    Participant Id

  • flexAcctId string Required

    A 10-character string representing an internal key assigned to a benefit account in the WCA system, used to uniquely identify the account. This value is left-padded with 0s, i.e., "0001699940".

  • Accept-Language enum<string>

    Specify the participant’s language preference. The corresponding response will then return text/string values in the language specified, defaulting to English if not specified or if an invalid value is sent. Note: If Spanish or French is requested and a particular field does not have a translated value (Spanish or French), then the English text value will be returned.

    Possible values: es en fr
  • decrypt integer <int32>

    Indicate if the URI parameters are encrypted or not. 1: encrypted, 0: decrypted, default to 0.

  • array <object>
    • SCId string

      Unique ID associated with the specific Administrator level Service Category.

    • SCName string

      The Service Category's name.

    • DefReimbMethodCde integer

      The Service Category's reimbursement method preference for crossover claims (claims flagged as "crossover claims") processed Manual claim import (II) record, Health care manual claim import (FX) record, SubmitManualRefund web service method, or SubmitHealthCareClaim web service method. Values: 0 = None (use participant default reimbursement method), 1 = External Reimbursement, 2 = Pay Provider or Participant, 3 = Always Pay Participant, 4 = Do Not Allow Auto-Pay

    • MaxTransAmt number <double>

      Maximum amount that can be authorized per manual claim for this service category.

    • MaxCategoryTotalAmt number <double>

      Maximum total amount that a participant may be reimbursed from this specific service category for the plan year.

    • CopayPerTransAmt number <double>

      The Service Category Copay Amount per transaction. This amount will not be approved for transactions within this Service Category. For example, if $20.00 is provided, then only $60 of an $80 transaction will be approved.

    • PercentPerTrans integer <int32>

      The Service Category Participant % Responsibility per transaction. The amount specified will be used to determine the eligible amount for a card or manual claim transaction within this Service Category. For example, if 20% is provided, then only $16 of an $80 transaction will be approved.

    • TierTypeId string

      Service Category Tier Type assigned to the service category.

    • CostShareOptions integer

      The Service Category Cost Sharing Rules. Values: 1 = Apply Copay and then apply %, 2 = Apply % and then apply Copay

    • SCCodes array <object>

      Collection of Service Category Codes assigned to the service category. See table below.

      • SCCode string

        The alphanumeric identifier for the Service Category Code.

      • Description string

        The description of the Service Category Code.

      • ServiceCategoryCodeTiers array <object>

        Provides tier level service category options. See table below.

        • TierKey integer <int32>

          Incremental integer value for the Service Category Tiers assigned, with the 'None' or default tier being 0.

        • TierId string

          Identifier of the Service Category Tier. A value of 'Null' corresponds to the 'None' or default tier.

        • BypassDeductible integer

          'Bypass Deductible' value of the Service Category Code: 0 = No, 1 = Yes

        • DeductibleNotMetAction integer

          'Deductible Not Met' value of the Service Category Code: 0 = Remove, 1 = Keep

        • ReimbTotalAmt integer

          'Total Participant Liability Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbDeductibleAmt integer

          'Deductible Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbCoinsuranceAmt integer

          'Coinsurance Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbCopayAmt integer

          'Copay Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbBenefitMaxMetAmt integer

          'Benefit Max Met Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbBenefitExcessAmt integer

          'Reference Based Excess Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbNotCoveredAmt integer

          'Not Covered Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

        • ReimbAboveRCAmt integer

          'Above R&C Amount' value of the Service Category Code: 0 = Neither Auto Pay nor Direct Submit, 1 = Auto Pay only, 2 = Direct Submit only, 3 = Auto Pay and Direct Submit

    • MCCodes array <object>

      Collection of Merchant Category codes assigned to the Service Category. See table below.

      • CardTypeCode integer

        Represents the card type or card network: -1 = None, 1 = MasterCard, 2 = VISA, 4 = American Express, 7 = All/IIAS

      • MerchantCategoryCode string

        A 4-character alphanumeric code, identifying the type of merchant. This code is encoded into the terminal by the issuing bank and transmitted with every transaction.

      • Description string

        The Merchant Category Code’s description.

      • MCCFlags integer

        Flag to identify whether plan is using one or more MCC account settings: None = 0, Deductible = 1, Claims Crossover = 2, UserDefdFlag1 = 4, UserDefdFlag2 = 8, UserDefdFlag3 = 16, UserDefdFlag4 = 32, UserDefdFlag5 = 64, UserDefdFlag6 = 128, UserDefdFlag7 = 256, UserDefdFlag8 = 512, UserDefdFlag9 = 1024, UserDefdFlag10 = 2048, Deductible Use = 4096

    • SpecialMCCodes array <object>

      Corresponds to the IIAS Options specified in WCA for the Service Category. Returned on the service as a collection of Special Merchant Category codes. See table below.

      • CardTypeCode integer

        Represents the card type or card network: -1 = None, 1 = MasterCard, 2 = VISA, 4 = American Express, 7 = All/IIAS

      • MerchantCategoryCode string

        A 4-character alphanumeric code, identifying the type of merchant. This code is encoded into the terminal by the issuing bank and transmitted with every transaction.

      • Description string

        The Merchant Category Code’s description.

      • MCCFlags integer

        Flag to identify whether plan is using one or more MCC account settings: None = 0, Deductible = 1, Claims Crossover = 2, UserDefdFlag1 = 4, UserDefdFlag2 = 8, UserDefdFlag3 = 16, UserDefdFlag4 = 32, UserDefdFlag5 = 64, UserDefdFlag6 = 128, UserDefdFlag7 = 256, UserDefdFlag8 = 512, UserDefdFlag9 = 1024, UserDefdFlag10 = 2048, Deductible Use = 4096