RxWaive

The cost and markup differences are automatically waived when the claim is paid for by only one online third party.

• When activated, an RxWaive indicator will appears in the Claim Summary window.
• Cost and markup adjustment is not possible when RxWaive has occurred.
• RxWaive will not waive the cost or markup if there are multiple online third party plans that pays for a portion of the claim.
• RxWaive will not occur for Cost and Markup Waiving if:
  • The prescription cost has been margin protected.
  • Billing code consists of only offline plans (e.g. CA, OK/CA).
• PPN and other Nexxsys waiving can still occur in conjunction with RxWaive.

The adjustment of the CoPay/Ded field is blocked when there is at least one online third party that accepts the claim and returns a copay or deductible. Unlike Cost and Markup Waiving, CoPay/Deductible Blocking will occur regardless of how many third party plans pay for the claim.

• When CoPay/Ded Blocking occurs, the CoPay/Ded and Patient Pays fields cannot be adjusted.
• RxWaive will not occur for CoPay/Ded Blocking if the billing code consists of only offline plans (e.g. CA, OK/CA).
• PPN and other Nexxsys waiving can still occur in conjunction with RxWaive.
• When CoPay/Deductible Blocking has occurred, and the CoPay/Ded amount is equal to the Patient Pays amount, the prescription will be automatically completed.
• When CoPay/Deductible Blocking has occurred, Patient Pays section in the Batch Profile window will be blocked from adjustment.

The Fee is prevented from being waived beyond a minimum value that is set in the database for all prescriptions regardless of online or offline claims.

• A prompt appears in the Claim Summary window to indicate if the fee is being waived is beyond the accepted minimum, and will present the maximum dollar value that can be waived.
  • Select OK. The cursor focus automatically moves to the fee adjustment field outlined in red.
• The fee validation logic checks the fee that was submitted.
• If PPN is applied to the prescription, there is no minimum fee validation.

Example 1

The minimum fee value is set to $12.00, and the submitted fee is $11.99. Assure paid $3.00 of the fee and the remainder fee difference must be charged to the patient because the minimum fee is greater than the submitted fee.

Example 2

The minimum fee value is set to $8.00, and the submitted fee is $11.99. Assure paid $3.00 of the fee, leaving a difference of $8.99. Therefore, up to $3.99 of the fee difference can be waived so that between the third party plan and the patient, the $8.00 minimum fee is paid for. The remainder fee difference must be charged to the patient because the minimum fee is less than the submitted fee.