How claim eligibility checks work

The encounter screen shows a live Claim eligibility preview alongside the form — a read-only view of how each funded program would respond to the encounter if you submitted it right now. It's indicative only: rules can change between when you read the panel and when the claim is checked at submission.

Why it's a preview, not a verdict

Eligibility for a funded program depends on facts that change as the encounter is filled in — the patient's age, the vaccine being recorded, answers to particular form fields, the site's state — and on rules the program itself sets. The preview re-evaluates those rules every time you change a relevant field, so you can see before submitting whether the encounter would be accepted, and if not, why.

The trade-off is that it can't promise the same answer at submission. Two things break that promise:

• Rules can move. A program can change its funded vaccine list, age window, or other criteria. The preview reflects the rules in effect when you opened the panel.
• Submission is the source of truth. The claim is re-evaluated server-side when it's submitted; that re-evaluation is the one that counts.

Treat the panel as a strong hint, not a promise.

Which programs get checked

Only programs that apply to the encounter's service and site appear. Today, that mostly means vaccinations submitted to AIR.

• NIPVIP (National Immunisation Program Vaccinations in Pharmacy) and CVCP (COVID-19 Vaccination in Community Pharmacy Program) are federal programs — checked on every site for services that submit vaccinations to AIR. The CVCP program ends on 30 September 2026. Eligible COVID-19 vaccinations given from 1 October are claimed under NIPVIP.
• State programs appear for sites in states that run their own funded vaccination program (Queensland, NSW, and WA today).

When no programs apply, the panel reads No claim checks apply.

How to read it

The panel groups by program, with one row inside each program per vaccine being recorded. Each row tells you whether that vaccine is eligible under that program right now, and if not, why — patient age outside the program's window, vaccine not on the program's funded list, a required answer missing on the form, and so on.

Recording a flu vaccine and a COVID-19 vaccine on the same encounter gives two rows per program. When the encounter covers more than one service, each service gets its own subheading.

What it isn't

• Not a submit button. The panel is read-only; submitting still happens from the encounter form.
• Not a guarantee. See Why it's a preview, not a verdict above.
• Not a check for non-AIR claim types. Manual claims and other reimbursement routes aren't part of this preview.