EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

HCP

HCP Health Care Pricing

Batch

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

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1473	Pricing Methodology	Rel	ID	2/2	1
2	782	Monetary Amount	Opt	Decimal	1/18	1
3	782	Monetary Amount	Opt	Decimal	1/18	1
4	127	Reference Identification	Opt	Alphanumeric	1/30	1
5	118	Rate	Opt	Decimal	1/9	1
6	127	Reference Identification	Opt	Alphanumeric	1/30	1
7	782	Monetary Amount	Opt	Decimal	1/18	1
8	234	Product/Service ID	Opt	Alphanumeric	1/48	1
9	235	Product/Service ID Qualifier	Rel	ID	2/2	1
10	234	Product/Service ID	Rel	Alphanumeric	1/48	1
11	355	Unit or Basis for Measurement Code	Rel	ID	2/2	1
12	380	Quantity	Rel	Decimal	1/15	1
13	901	Reject Reason Code	Rel	ID	2/2	1
14	1526	Policy Compliance Code	Opt	ID	1/2	1
15	1527	Exception Code	Opt	ID	1/2	1

Element Details

ID1473

NamePricing Methodology

LengthMin 2 / Max 2

Position1

RequirementRel

Codes

<>07Flat Rate Pricing
<>13Cost Reimbursed
<>14Adjustment Pricing
<>00Zero Pricing (Not Covered Under Contract)
<>12Ratio of Cost
<>01Priced as Billed at 100%
<>04Bundled Pricing
<>02Priced at the Standard Fee Schedule
<>05Peer Review Pricing
<>08Combination Pricing
<>11Lower of Cost
<>03Priced at a Contractual Percentage
<>06Per Diem Pricing
<>10Other Pricing
<>09Maternity Pricing