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
HCP01
Pricing Methodology
Identifier (ID)
Conditional
2
2
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
HCP02
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP02 is the allowed amount.
HCP03
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP03 is the savings amount.
HCP04
Reference Identification
String (AN)
Optional
1
50
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.
HCP05
Rate
Decimal number (R)
Optional
1
9
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.
HCP06
Reference Identification
String (AN)
Optional
1
50
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.
HCP07
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP07 is the approved DRG amount.
HCP08
Product/Service ID
String (AN)
Optional
1
48
1
Identifying number for a product or service
HCP08 is the approved revenue code.
HCP09
Product/Service ID Qualifier
Identifier (ID)
Conditional
2
2
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
HCP10
Product/Service ID
String (AN)
Conditional
1
48
1
Identifying number for a product or service
HCP10 is the approved procedure code.
HCP11
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
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
HCP12
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
HCP12 is the approved service units or inpatient days.
HCP13
Reject Reason Code
Identifier (ID)
Conditional
2
2
1
Code assigned by issuer to identify reason for rejection
HCP13 is the rejection message returned from the third party organization.
HCP14
Policy Compliance Code
Identifier (ID)
Optional
1
2
1
Code specifying policy compliance
HCP15
Exception Code
Identifier (ID)
Optional
1
2
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.

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