HCP Health Care Pricing

To specify pricing or repricing information about a health care claim or line item

Position: HCP-01 · Element: 1473 · Name: Pricing Methodology · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 1

Code specifying pricing methodology at which the claim or line item has been priced or repriced

R0113: At least one of HCP-01 or HCP-13 is required

Position: HCP-02 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

HCP02 is the allowed amount.

Position: HCP-03 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

HCP03 is the savings amount.

Position: HCP-04 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 50 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

HCP04 is the repricing organization identification number.

Position: HCP-05 · Element: 118 · Name: Rate · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 9 · Repeat: 1

Rate expressed in the standard monetary denomination for the currency specified

HCP05 is the pricing rate associated with per diem or flat rate repricing.

Position: HCP-06 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 50 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

HCP06 is the approved DRG code.

HCP06, HCP07, HCP08, HCP10, and HCP12 are fields that will contain different values from the original submitted values.

Position: HCP-07 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

HCP07 is the approved DRG amount.

Position: HCP-08 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 48 · Repeat: 1

Identifying number for a product or service

HCP08 is the approved revenue code.

Position: HCP-09 · Element: 235 · Name: Product/Service ID Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 1

Code identifying the type/source of the descriptive number used in Product/Service ID (234)

P0910: If either HCP-09 or HCP-10 is present, then the other is required

Position: HCP-10 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 48 · Repeat: 1

Identifying number for a product or service

HCP10 is the approved procedure code.

Position: HCP-11 · Element: 355 · Name: Unit or Basis for Measurement Code · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 1

Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

P1112: If either HCP-11 or HCP-12 is present, then the other is required

Position: HCP-12 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: 1

Numeric value of quantity

HCP12 is the approved service units or inpatient days.

Position: HCP-13 · Element: 901 · Name: Reject Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 1

Code assigned by issuer to identify reason for rejection

HCP13 is the rejection message returned from the third party organization.

Position: HCP-14 · Element: 1526 · Name: Policy Compliance Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code specifying policy compliance

Position: HCP-15 · Element: 1527 · Name: Exception Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code specifying the exception reason for consideration of out-of-network health care services

HCP15 is the exception reason generated by a third party organization.