Code of Federal Regulations (Last Updated: July 5, 2024) |
Title 45 - Public Welfare |
Subtitle A - Department of Health and Human Services |
SubChapter C - Administrative Data Standards and Related Requirements |
Part 162 - Administrative Requirements |
Subpart K - Health Care Claims or Equivalent Encounter Information |
§ 162.1101 - Health care claims or equivalent encounter information transaction.
Latest version.
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§ 162.1101 Health care claims or equivalent encounter information transaction.
The health care claims or equivalent encounter information transaction is the transmission of either of the following:
(a) A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care.
(b) If there is no direct claim, because the reimbursement contract is based on a mechanism other than charges or reimbursement rates for specific services, the transaction is the transmission of encounter information for the purpose of reporting health care.