Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

Waive member co-pay

Updated on April 26, 2021

The member co-pay for an unplanned readmission may be waived, based on a user-defined look-back period configured in the Application configuration page (the Pega-provided default is 48 hours).

The intent of the WPC action code is to trigger the waiving of member co-payment for the claim determined to represent a hospital readmission. This should be a default action, so that when a user completes the line-level pricing for a readmission, the member’s co-pay for that claim is automatically waived. However, if the user elects not to reprice the claim (e.g., selects override, no action required, etc.), the waiver will be removed, and the co-pay will be applied.

When the co-pay is waived, Smart Claims Engine for Healthcare sets a $0.00 in the member co-pay field in the claim line Execution results UI, and displays a note in the Claims history.

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us