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

Table 1. 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 {1} The period (unit of measure) of the waiting period regime {2} The code of the waiting period regime {3} The start date of the waiting period {4} Description of the product {5} Description of the benefit specification {6} Benefit specification Procedure group description or the Procedure condition description {7} Benefit specification Diagnosis group usage concatenated with the Diagnosis group description or the Diagnosis group condition description {8} 'Parameter' or 'Limit' depending on the covered service type {9} Service Option Service Code
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 {1} The period (unit of measure) of the waiting period regime {2} The code of the waiting period regime {3} The start date of the waiting period {4} Description of the product {5} Description of the benefit specification {6} Benefit specification Procedure group description or the Procedure condition description {7} Benefit specification Diagnosis group usage concatenated with the Diagnosis group description or the Diagnosis group condition description {8} 'Parameter' or 'Limit' depending on the covered service type {9} Service Option Service Code
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.