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Eligibility 

Eligibility

Eligibility determines whether a member is authorized to use the Wellframe app. This authorization is determined by you, the customer. 

Wellframe receives eligibility data either via files that are securely sent to us, or via an API (Application Programming Interface). Wellframe ingests the data exactly as we receive it. If you are unsure of what type of eligibility your organization is using, please reach out to your internal supervisor or data team. 

Typically, if you are encountering an “eligibility” issue with an authorized member, it is because Wellframe has not yet received that information from your organization or there is an issue with the data we have received. 

If you have a member profile that you believe should be eligible, however, it is displaying as “not eligible” in Wellframe, please contact your internal team first to confirm the following: 

  1. Is the MemberID and DOB on the member profile, correct? 
    • If so, was that member’s information included in the latest eligibility data that was sent to Wellframe? 
  2. Is the member still eligible? Please confirm their policy coverage dates. Lapses in coverage can cause a member to lose eligibility briefly. 
  3. Is the information they are sending to Wellframe (MemberID and DOB) correct? 
  4. When was that member’s eligibility updated and sent to Wellframe? 

Note: It may take up to 24hrs for a member’s eligibility status to update in Wellframe, from when we receive the information.  

If you are unable to resolve internally why the member is displayed as ineligible, then you should reach out to help@wellframe.com for assistance. 

What if the MemberID on the member’s profile is incorrect? 

You can resolve this issue by updating the MemberID on the member’s profile. 

  1. Drill into the Member Profile 
  2. Click on Member Settings 
  3. In the Member Details section locate the “Member ID” field 
  4. Type in the correct MemberID 
  5. Click “update” 
  6. The member should regain eligibility overnight as long as Wellframe has received the updated data from your organization.  

Note: For API based eligibility, if your data is not configured for Wellframe, you will receive an error immediately when clicking update and not be able to update. Please circle back with your internal teams.