Enrollees in CHIP are required to pay co-payments for services received unless exempt. The household member pays a small amount towards health services received and the household member's health plan pays the rest, after being billed by the service provider. A receipt of the co-payment is needed to track the total amount of co-payments made by case participants within a particular Children's Health Insurance Program product delivery case.

When the total value of the co-payment receipts received is equal to or greater than the maximum co-payment limit. The Co-payment limit indicator is set on the Co-payment entity. Notification is sent to the case participant and to the Children's Health Insurance Program service provider stating that no further co-payment payments are necessary for services supplied under this Children's Health Insurance Program product delivery case.

This is a business processing entity which is associated with the Children's Health Insurance Program product delivery. An organization's administrator must administer certain entities when creating and maintaining Children's Health Insurance Program product deliveries.

Example

Susan Smith is a child in a household who is currently receiving Children's Health Insurance. Susan Smith is ill and attends her local doctor. Susan Smith's doctor prescribes her drugs. The doctor issues a bill for the service he supplied and the cost of the drugs for Susan Smith. Susan Smith pays a portion of the cost of the service provided by her doctor. A case worker creates a CoPayment Receipt record of the payment Susan Smith has made to her doctor.