EDI
API DocsTerminal

HCP Health Care Pricing

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

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1473
Pricing Methodology Code
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
Codes (15)
02
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP02 is the allowed amount.
03
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP03 is the savings amount.
04
Reference Identification
String (AN)
Optional
1
80
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.
05
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.
06
Reference Identification
String (AN)
Optional
1
80
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.
07
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
HCP07 is the approved DRG amount.
08
Product/Service ID
String (AN)
Optional
1
80
1
Identifying number for a product or service
HCP08 is the approved revenue code.
09
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
Codes (544)
10
Product/Service ID
String (AN)
Conditional
1
80
1
Identifying number for a product or service
HCP10 is the approved procedure code.
11
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
Codes (925)
12
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
HCP12 is the approved service units or inpatient days.
13
Reject Reason Code
Identifier (ID)
Conditional
2
2
1
Code identifying reason for rejection as assigned by issuer
HCP13 is the rejection message returned from the third party organization.
Codes (259)
14
Policy Compliance Code
Identifier (ID)
Optional
1
2
1
Code specifying policy compliance
Codes (5)
15
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.
Codes (6)

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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.