Segment
X12 EDI Release 00304
To specify pricing or repricing information about a health care claim or line item
Elements
  • HCP011473Pricing Methodology
    ID
    M必须(Mandatory)

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

    Codes (15)
  • HCP02782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • HCP03782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • HCP04127Reference Number
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

  • HCP05118Rate
    R
    O可选(Optional)
    Min 1 / Max 7

    Rate at which the special charge is determined expressed in the standard monetary denomination for the currency specified.

  • HCP06127Reference Number
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

  • HCP07782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • HCP08234Product/Service ID
    AN
    O可选(Optional)
    Min 1 / Max 30

    Identifying number for a product or service.

  • HCP09235Product/Service ID Qualifier
    ID
    O可选(Optional)

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

    Codes (307)
  • HCP10234Product/Service ID
    AN
    O可选(Optional)
    Min 1 / Max 30

    Identifying number for a product or service.

  • HCP11355Unit or Basis for Measurement Code
    ID
    O可选(Optional)

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

    Codes (719)
  • HCP12380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • HCP13901Reject Reason Code
    ID
    O可选(Optional)

    Code assigned by issuer to identify reason for rejection.

    Codes (81)