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Back  RFI # 340: HCP02 Allowed Amount

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Submitter

Kelly Butler

Description

HCP02 does not specifically state that zero '0' is an allowable value for this field, however the field is required per HIPAA, optional for X12.

Is it appropriate for a provider/repricer to enter a zero '0' in HCP02 (regardless of the value in HCP01) when submitting repricing segments for zero line charges (such as reporting an injection for which there was no charge to the patient but the provider wants the payer to be aware that it was given)?

Response

This issue is explicitly addressed in guide 004010X098. When repricing information is sent at the line level in an HCP segment, the HCP02 is required as specified in the guide by the data element usage. When the Repriced Allowed Amount is $0, "0" is the proper value for HCP02.

The specifications for a Decimal data element in section A.1.3.1.2 of Appendix A, ASC X12 Nomenclature, states: "Leading zeros should be suppressed unless necessary to satisfy a minimum length requirement." In the case of HCP02 with a zero value, the element is required and the minimum length is 1, therefore the zero must be sent."

Recommendation

Submission 10/18/2005
Status Date 12/6/2005
Status F - Final
Primary References
Document 004010X098A1
Section00000000
Page0472
Set ID000000
Table2
Loop2400
Segment IDHCP
Element Position02
Industry NameRepriced Allowed Amount