Waives Frequently Asked Questions
This topic is intended for Independent pharmacies only and is not applicable to Rexall pharmacies.
Can I waive amounts before a claim is passed to the next Third Party plan in a coordination of benefits (COB) scenario?
No. Waives apply to the last Third Party plan being billed. There is no automatic or manual waiving allowed in between.
How come a $2 cost waive set at the batch level didn't apply to a prescription that had a remaining cost of $2.01 after adjudication?
Waives set at the batch level apply when the difference returned for that cost aspect is equal to or less than the waive amount. For a $2 waive to apply, the cost difference must be $2 or less.
How are patient level waives different from group and batch level waives?
Patient waives are not dependent on the differences returned by the Third Party. They will apply regardless of what is returned. Group and batch waives follow a threshold. They only apply if the difference returned is equal to or less than the waive amount.
I don't want to review the Claim Summary if the Patient Pays amount is $1.00 or less. Is there a way to bypass this?
Yes. You can set the Acceptance Threshold in the Pricing module, Group Folder, Batch Preferences, and/or Patient Folder. For more information, see Skipping the Claim Summary Window.
I want to waive $0.50 from the Patient Pays amounts for all my patients in a group when I batch, regardless of what the Patient Pays amount is. Is there a way to do this?
This can be done for each patient as a Total Rx Waive. Total Rx Waives allow a waive to be applied to different cost aspects until it's fulfilled. This type of waive is only available at the patient level. For more information, see Patient Waives.
I promised Patient A I'll always waive $5.00 from their prescription total. How can I do this?
You can set a Total Rx Waive of $5 in the Patient Folder. For more information, see Patient Waives.
If the patient does not have Third Party insurance (cash paying), you cannot apply any waives. However, you can set up a reduced fee (i.e., $5 less) for a House Charge or Nursing Charge plan and add that plan to the Patient Folder. For more information, see Setting Up Dispensing Fees for specific patients.