Within the VaxCare Portal, there are three different billing methods:
- Insurance Pay means that VaxCare will bill for both the CPT on the vaccine and the CPT on the administration of that vaccine. This also means, by nature, that your office does not bill for any portion of the patient's vaccines. It is important that you follow our billing expectations (below) to prevent double-billing of the patient's insurance policy, which can result in charge backs.
- Partner Bill means that you, as our partner, are responsible for billing both the CPT on the vaccine and the CPT on the administration. When an encounter must be Partner Billed, instead of billing per usual, VaxCare will deduct the base cost of that vaccine from your next compensation check. This payment option is defafulted to when a patient has an insurance plan that is not currently contracted with VaxCare, when they are receiving a vaccine that is knowingly out of age indication, or when the patient has a clinical reason to receive a vaccine that might otherwise not be covered by their insurance company. It is your responsibility to notify us of doses administered due to medical necessity, rather than for preventative reasons.
- The Self Pay option is used when a patient does not have insurance coverage for their vaccines and/or they do not wish to give you their insurance information. For Self Pay encounters, your office is responsible for collecting payment from the patient for the vaccine and administration of that vaccine. Your Office Manager will set your office-specific Self Pay rates, and the patient will pay you directly, at the time of service, for their vaccines. For more information, see Setting Self Pay Rates.
Partner claims can be found and accounted for by navigating to Billing > Partner Billing in your VaxCare Portal.
VAXCARE'S BILLING EXPECTATIONS FOR ALL PARTNERS
Our expectations for all partners -- but particularly those partners who are new -- are that you work with your practice administrator to turn off automatic billing of vaccines in your EMR (to prevent double-billing) and that you set your Self Pay rates prior to vaccinating your first Self Pay patient.
We expect that you understand the billing scenarios outlined above and that you will reach out to our Customer Care team immediately as any questions arise.
If you accidentally file a claim for the same patient/vaccines/encounter for which VaxCare was supposed to bill, our expectation (according to our Terms of Service) is that you will remove your claim and/or reimburse the insurance company from which you have already been paid. If the amount cannot be reimbursed and VaxCare's claim was denied because of the double-billing, we will charge your practice for the cost of the vaccine(s) for that encounter.
Patients must be checked out within 90 days of their date of service to avoid denials for timely filing. If we are unable to bill for vaccines for this reason, your practice will be responsible for collecting on the claim for the encounter.
PLEASE NOTE: Intentionally billing for claims that VaxCare has already billed (or is expected to bill, because the shots are listed as Insurance Pay upon patient check-in) constitutes insurance fraud and will be grounds for termination from our program.
It is your responsibility to reconcile your Statement reports every month and bill for any outstanding vaccines for which VaxCare did not (or could not) bill. This report is released on the 15th of every month (or the following Monday if the 15th falls on a weekend), and details exactly what contributed to, or deducted from, your compensation check for that month. For help with reconciling your statement, or for determining reasons why VaxCare did not (or could not) bill, see the eligibility response by clicking the patient's name from the list of transactions on your Statement summary in your Portal.
VaxCare is not responsible for billing errors for vaccines given outside of our program billing guidelines above.
Still have questions? Reach out to our Customer Care team. We're happy to help! Message us directly by clicking on the blue Intercom bubble in the bottom right corner of your screen. Email us at firstname.lastname@example.org. Or call us at 1-888-829-8550.