Waiting Period Regimes
Waiting period regimes are used to configure qualification periods for specific benefits within a product. These circumstances and rules will be specified in a waiting period regime. The length of the waiting period is defined in the waiting period regime. Consider the following example:
Payer A postpones coverage for 6 months for all orthodontic services for all patients. For any other service, the evaluation of benefit regimes starts at the first day of product subscription.
Waiting Period Regime
Field | Description |
---|---|
Code |
Identifier for this regime |
Description |
Descriptor of this regime |
Length |
An integer representing the length of the waiting period. |
Period |
Specifies whether the length should be interpreted as number of days, months or years. |
Period Start Date Function |
Specifies the logic that derives the start date used to measure the waiting period |
Message |
The message that is attached to the claim line when the service date in the claim line is in the waiting period. The available placeholders for this message are:
|
Consider the scenario of payer A. In the scenario of payer A, the set up needs just one regime for "Waiting periods orthodontic services". This scenario requires the following setup:
-
Regime <Orthodontic Services> applies to any serviced person for the first <6><months> after enrollment.