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 Fields
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. |
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: {0} The period of the waiting period regime |
Message (continue) |
The message that is attached to the claim line when the service date in the claim line is in the waiting period, and the system will check if older products serve the waiting period. The available placeholders for this message are: {0} The period of the waiting period regime |
Dynamic Logic Function |
Specifies the dynamic logic function that determines the waiting period start date for this regime. |
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 Service_>
applies to any serviced person for the first<6>`
<months>` after enrollment.