A CAP code (also called a construct, bundle, or kit) is a facility-specific code that covers a procedure or group of items at a single fixed price. Instead of pricing each item individually, the CAP code acts as a package — for example, a total knee replacement might have a CAP code that covers the implant components, trial instruments, and any ancillary items as one billable unit.
In Helia, CAP codes are added to a case as a catalog line item, just like any other product. When you add the CAP code to your case, it applies capitated pricing to the items it covers.
For example, a total joint replacement case might look like this:
Femoral Component — $0
Tibial Insert — $0
Tibial Tray — $0
Patellar Component — $0
CAP Code: Total Joint Construct — $4,200.00
Why your case was rejected for a missing CAP code
If your case was rejected and the comment mentions a missing CAP code, construct, bundle, or kit, one of these is usually the cause:
The CAP code item wasn't added to your case. Open the rejected case, search the catalog for the CAP code (your billing sheet or the facility's supply chain team can confirm the correct one), add it as a line item, and resubmit.
The CAP code isn't in Helia's contract yet. This happens when a code is newly negotiated or not yet loaded for your facility. If you can't find it in the catalog at all, click the chat icon in the bottom right corner to submit a ticket with your DO# and the code — our team will load it if it's missing.
You selected capitated pricing when line item pricing was correct, or vice versa. When adding items, make sure the pricing type matches your billing sheet.
Where to find your CAP code
Your billing sheet is the most reliable source. The facility's supply chain or billing coordinator can also confirm the correct code for a given procedure or department.
Note: CAP codes are facility and contract-specific. A code that works at one hospital won't necessarily apply at another, and newly negotiated codes may take a business day or two to be loaded into Helia. If a code should be on contract but isn't showing up, submit a ticket by clicking the chat icon in the bottom right corner, rather than substituting a different item or code.
Still need help? Click the chat icon in the bottom right corner to submit a ticket.