Insurance Pay is the default method of payment when checking in a patient and 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.
Partner Bill means that you, as our partner, have elected to bill for your patient's vaccines for this encounter. When you choose Partner Bill upon patient check-in, your office will bill for both the CPT on the vaccine and the CPT on the administration, then VaxCare will deduct the base cost of that vaccine from your next compensation check. This payment option is generally only used 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 would otherwise not be covered by their insurance company.
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. 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.
VAXCARE 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.
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 Compensation Detail 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 Compensation Detail report, or for reasons why VaxCare did not (or could not) bill, see Compensation Detail Report.
VaxCare is not responsible for billing errors for vaccines given outside of our program billing guidelines above.
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