How claiming works

Claims in Light go to two different kinds of destination: AIR and PPA. They share a list and a lifecycle, but their submission and amendment behaviour differs because the providers do.

AIR vs PPA

AIR (Australian Immunisation Register)

AIR is the clinical record. Every eligible vaccination should flow to AIR as a matter of compliance — there's no "submit when you're ready", because the vaccination has already happened.

So AIR claims submit themselves. When an encounter is complete and AIR-eligible, Light creates the claim, submits it, and transitions through Pending → Submitted → Accepted or Rejected without your involvement.

You still see AIR claims on the Claims page — that's where you see rejections and errors. But the happy path doesn't need manual input.

PPA (Pharmacy Programs Administrator)

PPA is the funding body. Submitting a claim to PPA is a financial and legal act — you're claiming money against a program and attesting to the patient's eligibility.

PPA claims used to need explicit per-claim sign-off, and the manual flow is still available. The shift in 2026 was toward program-level enrolment: instead of acknowledging the declaration on every individual claim, you sign the program's agreements once at Settings›Programs and Light submits eligible claims on the program's cadence. The legal representation is now made at enrolment time and re-affirmed every time a new agreement version ships. Claims still reach Ready first, so you have a chance to amend or remove anything that shouldn't go out.

State-funded programs

State health departments fund some vaccinations directly rather than through PPA — QLD Free Flu (Queensland Health) and NSW Free Intranasal (Limited) (NSW Health) are the live examples. These follow the same Ready / Submitted lifecycle as PPA claims, but the submission route is different: instead of an API call to PPA, Light batches eligible claims into a fortnightly invoice (with a Request for Payment Declaration PDF) and emails it to the department. Configuration sits at Settings›Programs alongside the PPA programs.

Claims are tied to services, not bookings

The claim belongs to a customer service — a single instance of a service delivery. This means:

• If the booking is deleted but the service was recorded, the claim still exists and is still claimable
• If the service is cancelled, related claims don't auto-cancel — they may move to Ineligible, or they may need manual attention
• Claims can't be transferred between services; a claim for one customer's vaccination can't be repurposed for someone else's

One service can have multiple claims if it's eligible for multiple programs — a COVID-19 vaccine might generate both a CVCP claim and an AIR encounter claim from the same encounter.

Amendment preserves context

When you amend a rejected claim, Light keeps the prepared payload and lets you edit only the fields that make sense to change on the claim itself — vaccinator AHPRA, batch number, service date, dose number.

The patient's identity, vaccine brand, and AIR code are read-only on the amend sheet. Those are tied to the underlying encounter — if one of those is wrong, you're fixing the encounter (and its AIR record), not just the claim.

This split matters because:

1. Amending a claim shouldn't silently change what's on AIR
2. Identity changes should go through the customer record (and flow to every affected system) rather than being hacked claim-by-claim

Why some claims are Ineligible

Ineligible claims are claims Light evaluated but decided not to prepare — usually because of an eligibility rule:

• The patient doesn't meet age requirements for the program
• A prior dose was recorded under a different program, disqualifying this one
• The service was delivered outside the program's eligibility window

You can amend an Ineligible claim if Light has reason to believe the evaluation was wrong. More often, the evaluation is correct and the claim stays Ineligible indefinitely — it's a record that the service happened, but wasn't funded.

Removing a claim

If a prepared claim is wrong enough that re-evaluation won't fix it — a duplicate, a claim that should never have been created, or one a customer has asked you not to lodge — you can remove it from the claim's row. Choose a reason (Duplicate, Invalid, Customer request, or Other with details) and confirm; the claim moves to Removed and stays there. Removed claims are terminal: they won't be submitted and re-evaluating the encounter won't bring them back. Accepted and Submitted claims can't be removed.

See Removing a claim for the task-level walkthrough.

When the provider changes the rules

CVCP eligibility, PPA declarations, NIPVIP cohorts — these change. When a program updates, existing Ready claims get re-prepared by Light so they use the new rules. Submitted, Accepted, and Rejected claims stay with whatever rules applied when they were submitted — that's their historical record.

This is why an ancient Rejected claim might not be amendable any more: the program it belonged to may no longer exist.

No dashboard yet

The Claims page has status summary cards — counts by status at the top — but there's no trend, rejection-rate, or program-level reporting yet. Claim volume and outcomes reporting is on the roadmap. For now, the status cards are the closest thing to an at-a-glance view.