​When trying to schedule and bill for annual wellness visits (including immunizations) for children and adolescents, please first confirm your patient's benefit eligibility. Coverage is based on a patient's insurance plan:

• Most of our members have a Calendar Year benefit: This means that patients can be scheduled on any date in a new calendar year. For example, a patient who came for a wellness visit in 2021 can be scheduled for their next annual visit on any date in 2022.
• Only a small percentage of our members have a Contract Year benefit: When scheduling these patients, you must wait 365 days from the last well visit before you can schedule the patient for their next annual well visit.

Participating providers can check a patient's Eligibility & Benefits and view Gaps in Care reports on the Provider Engagement, Analytics & Reporting (PEAR) portal. Your access to PEAR is determined by your organizational role and is set up by your Organization Administrator. To request access to a PEAR application, please contact your Organization Administrator.

How to check eligibility

The easiest way to check a patient's scheduling eligibility is through our PEAR portal, using the PEAR PM (Practice Management) application:

1. Sign into PEAR
2. Go to PEAR PM (you must be approved by your administrator for access)
3. See Eligibility & Benefits
4. Check the patient's ID or name and DOB (you may need to confirm the primary care site)
5. Look under Benefit Usage
6. See Benefit Plan Period
7. Look for text on the right that indicates whether that patient has Contract or Calendar year eligibility

Remember: If your patient is under a Contract year plan, you must wait 365 days from their last appointment before scheduling their next annual wellness visit.

Scheduling immunizations

Schedule immunizations according to your patient's benefit eligibility (calendar or contract year). Routine immunizations are generally covered as preventive health care; please check our Medical Policy for specifics.

For further guidance on vaccination schedules, check these resources:

• Preventive care for AmeriHealth New Jersey and AmeriHealth Pennsylvania
• Recommended Childhood and Adolescent Immunization Schedule: United States, 2021

How to view Gaps in Care report

For added support, you can check the clinical care record for your patients from AmeriHealth by accessing the Gaps in Care report in the PEAR AR (Analytics & Reporting) application:

1. Sign into PEAR
2. Go to PEAR AR (you must be approved by your administrator for access)
3. Click on Report Center at the top of the page
   
4. Navigate to Population Health Reporting (dropdown menu)
5. See boxes; click on Gaps in Care (add to cart)
6. You can name the file if you wish to save it for later
7. Go to the cart on the right and hit Submit
8. To access the report, click on Output Manager at the top of the page
9. You will see all Report Submissions. Click the top item in that list
10. The file is now available to download (may take several minutes)
11. You can search by member (or change filters as you wish)