When adjudicating an entire claim using the Claim Pricing Code table, decisions are based on a single characteristic of the claim.

• A. True
• B. Not sure
• C. It depends
• D. False

Answer: (A)

This is true because the Claim Pricing Code table assigns a single price to the entire claim based on one defining characteristic of the claim. In this approach, the pricing decision is driven by that one attribute—identify the characteristic, apply the corresponding pricing code, and that code determines the total payment for the whole claim. Other details or line items don’t change the outcome once that single characteristic has mapped to a price. So the adjudication hinges on one primary factor, not a combination of multiple factors.