HCP Health Care Pricing
To specify pricing or repricing information about a health care claim or line item
Position
Element
Name
Type
Requirement
Min
Max
Repeat
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
Monetary amount
HCP02 is the allowed amount.
Monetary amount
HCP03 is the savings amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
HCP04 is the repricing organization identification number.
Rate expressed in the standard monetary denomination for the currency specified
HCP05 is the pricing rate associated with per diem or flat rate repricing.
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.
Monetary amount
HCP07 is the approved DRG amount.
Identifying number for a product or service
HCP08 is the approved revenue code.
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
Identifying number for a product or service
HCP10 is the approved procedure code.
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
Numeric value of quantity
HCP12 is the approved service units or inpatient days.
Code identifying reason for rejection as assigned by issuer
HCP13 is the rejection message returned from the third party organization.
Code specifying policy compliance
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.