Get claim submittal form

https://api.wealthcare.com/participant/services/participant/claims/{tpaId}/{employerId}/{participantId}/{trackingNumber}

Get claim submittal form for printing by user.

Path parameters

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
trackingNumber string Required

Number you assigned to track export of the claim or QLE back to your own application.

Query parameters

decrypt integer <int32>

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

Response

TpaId string

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

Indicates if your admin instance has fax routing enabled.
TrackingNumber string

Number you assign to track claims. Note: WCA does not use this number.
BarCodeStream string <byte>

The String Representation of the barcode image to be included on the claim submission form.
BarCodeSymbologyType integer

Indicates the type of bar code that is represented in the bar code stream (a symbology is a defined method of representing numeric or alphabetic digits using bars and spaces that are easily scanned by computer systems). None = 0, Code39 = 1, Code39Ext = 2, Code128 = 4, EAN128 = 8, Code93 = 16, Code93Ext = 32
ReceiptInstruction string

The Receipt Instruction text as configured on the Receipt Form tab of the Claim Entry Template in WCA.
ParticipantClaimList array <object>

Participant Claim List
- TpaId string
  
  A unique identifier used to identify your admin instance. This value was system generated with the admin instance was created.
- EmployerId string
  
  Unique identifier for the employer. Note: WealthCare Admin assigns the 3-character prefix; you assign the remaining characters.
- TransactionDate string <date-time>
  
  Date of the transaction
- ServiceStartDate string <date-time>
  
  Service Start Date for the claim
- ServiceEndDate string <date-time>
  
  Service End Date for the claim
- Type string
  
  A code indicating the type of transaction this is: Deposit = 0, Card = 1, Bank = 2, HSA Online Recurring Payment = 3, HSA Online Single Payment = 4, Fee = 5, Transfer = 6, ACH Credit = 7, ACH Debit = 8, Check = 9, Commission = 10, Interest Payment = 11, Recurring Claim = 12, Claim = 13, Manual Claim = 14, Fee Paid To Admin = 15, Fee Paid By Admin = 16, Fee Paid To Employer = 17, Fee Paid By Employer = 18
- Claimant object
  - TpaId string
    
    A unique identifier used to identify your admin instance. This value was system generated with the admin instance was created.
  - EmprId string
    
    Unique identifier for the employer. Note: When the employer was created, WealthCare Admin assigned the 3-character prefix; you assigned the remaining characters.
  - CardholderKey integer <int32>
    
    A system generated key used to indicate the specific employee or dependent.
  - LastName string
    
    The last name of the claimant.
  - FirstName string
    
    The first name of the claimant.
  - SocSecNum string
    
    Depending on the CardholderTypeCde, this will be the employee ID or the dependent ID (this is not necessarily an actual SSN unless you use SSNs for your employee IDs).
  - NamePrefix string
    
    The prefix for the claimant's name. Valid values are Mr., Mrs., Ms., Dr., and Rev.
  - Initial string
    
    The middle initial of the claimant
  - CardholderTypeCde integer <int32>
    
    Cardholder Type Cde: Employee = 1, Dependent = 2
  - CardNum string
    
    Card Proxy Number
- AcctTypeCde string
  
  The account type code for the benefit account the claim is processed under.
- AcctTypeDesc string
  
  The account type description for the benefit account the claim is processed under.
- AccountKey integer <int32>
  
  A system generated ID for the benefit account the claim is processed under.
- PlanStartDate string <date-time>
  
  Plan Start Date for the account the claim is processed under
- PlanEndDate string <date-time>
  
  Plan End Date for the account the claim is processed under
- Status string
  
  Claim status
- TxnAmt number <double>
  
  Transaction Amount
- FlexAcctKey integer <int32>
  
  A system generated ID for the benefit account the claim is processed under. Same value as AccountKey
- TxnAmtOrig number <double>
  
  Original Transaction Amount
- TxnAmtDenied number <double>
  
  Transaction Denied Amount
- TxnAmtPending number <double>
  
  Transaction Pending Amount
- TxnCde integer <int32>
  
  Transaction Code
- TxnMsg string
  
  Transaction Message
- TxnAmtRefund number <double>
  
  Transaction Refund Amount
- TxnOriginCde integer
  
  Transaction Origin Code: None = 0, POSCardSwipe = 1, POSKeyedIn = 2, POSPhonedIn = 3, POSMbiSubmitted = 4, ManualScreen = 50, ManualEFT = 51, ManualAgent = 52, ParticipantManualScreen = 53, ParticipantMobileScreen = 54, HZDirect = 55, eClaimManagerManual = 56, eClaimManagerTPS = 57, WebServiceClaim = 58
- TxnOptions integer
  
  Transaction Options
- CardHolderDisplay boolean
  
  True if the claim the receipt is attached to should display to the participant. False if the claim should not be displayed to the participant.
- ProviderId string
  
  Provider Id on the claim
- ProviderDesc string
  
  Provider Description on the claim
- FileKey integer <int32>
  
  A system generated ID used to identify the receipt just uploaded.
- HasReceipt boolean
  
  True if the claim has a receipt attached to it.
- ReceiptExpired boolean
  
  Returns true if the receipt has expired. Returns false if the receipt is still active. If the document routing feature is not enabled, documents are retained for 30 days after the transaction has been adjudicated. If the document routing feature is enabled, documents are stored for three years and then archived. Documents containing eSignatures are stored on the claim as long as the claim is visible in WCA
- ReceiptsInfo array <object>
  
  Receipt Information
  - TpaId string
    
    A unique identifier used to identify your admin instance. This value was system generated with the admin instance was created.
  - FileKey integer <int32>
    
    A system generated ID used to identify the receipt file.
  - DocId string
    
    A system generated ID created when a file is submitted through a document queue instead of by a participant.
  - DocDisplayName string
    
    Document Display Name
  - OriginalFileName string
    
    Original File Name
  - UploadDate string <date-time>
    
    The date the receipt file was uploaded.
- DisplayableFields array <object>
  
  Displayable Fields
  - OriginalFieldName string
    
    This is the original name of the field, as assigned by Alegeus.
  - AlternativeFieldName string
    
    If an Alternative Field Name has been configured in WCA (Claim Entry Template or Edit Plan) for this field, it will be returned here. This value should be used for the field display if DisplayOptions = 2.
  - DisplayOptions integer
    
    Numeric code used to indicate what should be displayed for this field: Don't Display = 0, Original Field Name = 1, Alternative Field Name = 2
  - DisplaySpecifications integer
    
    A bitwise value used to indicate how this value should be displayed: None = 0, IsVisible = 1, IsRequired = 2, IsOptional = 4, IsReadOnly = 8, MAX_COMMON_VALUE = 4294967296
- InsertDate string <date-time>
  
  The date the claim was inserted.
- UpdateDte string <date-time>
  
  The last update date of the claim
- InsertUserIdKey integer <int32>
  
  A system generated ID for the user ID that inserted the claim.
- UpdateUserIdKey integer <int32>
  
  A system generated ID used to identify the user that last updated the claim
- ExpenseKey integer <int64>
  
  This will return 0 when on a UploadManualClaimReceipt response.