What is Eligibility?

Like in your EHR, eligibility with VaxCare describes a patient's vaccine coverage. 

How eligibility differs with VaxCare is that we are only able to relay eligibility information for patients with payers (insurance) that are in-network with VaxCare (or VaxCare Bill payers). If a patient has a payer out-of-network with VaxCare (or Partner Bill payers) or is uninsured, we are unable to perform an eligibility check (see article 'Partner Bill and Self Pay'). Don't worry, we'll highlight these patients for you.

Getting to Guaranteed Payment (Risk Free)

The good news is that most patients are insured with payers in VaxCare's network. For all of these patients our goal is to get them to Risk Free, which guarantees you are paid for all administered doses (as long as the patient is within the age range indicated on the vaccine). 

Eligibility Responses

Our eligibility system is simple. These responses are used to quickly and accurately inform you of your patient's eligibility status while simultaneously providing you with next steps in the event that further action is required. Understanding these responses is important to knowing where your practice or patients bear financial responsibility.

Our goal with this eligibility system is to make it easy for you to get all appointments to Risk Free so you are guaranteed payment.

Eligibility messages fall into one of the following categories:

Ready to Vaccine (Risk Free)
No Financial Responsibility, Guaranteed Payment

This status is what you are looking for. This guarantees you are paid for any administered dose that meets the requirements.

Partner Bill or Self-Pay
Financial Responsibility of Practice or Patient

This message is displayed when a payer is out of the VaxCare network, if the patient is uninsured, or if the patient has opted to self-pay for vaccines.

Missing or Invalid Information
Possible Financial Responsibility of Practice

This message is displayed when we are missing information that is valuable to our billing process. It isn't always necessary to ensure compensation, but fixing these issues gets you to Risk Free, guaranteeing you get paid.

Eligibility Issue
Financial Responsibility of Practice

This message is displayed when there is a error that we know will prevent us from billing a claim and therefore result in a charge-back. 

Where to Find Eligibility Information

Eligibility messaging and corresponding icons can be found on the patient's schedule, the appointment and claim pages.

Resolving Eligibility Issues

See "How to: Update Patient Information to Resolve Eligibility Issues" (link below) for more information.

How and When Eligibility results are updated

For Integrated Partners: Eligibility results will automatically update when you schedule or update a patient appointment or demographic information in your EHR. 

For Non-Integrated Partners: Eligibility results will automatically update any time you add a new patient appointment, add a new patient, or edit existing patient information. 

Related Content:  

How To: Clean-Up Missing or Invalid Information

How To: Clean-Up Eligibility Issues

How To: Add Appointments to the Schedule (Non-Integrated Partners Only)

How To: Update Patient and Insurance Information (Non-Integrated Partners Only)

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