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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 45 - Public Welfare |
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Subtitle A - Department of Health and Human Services |
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SubChapter C - Administrative Data Standards and Related Requirements |
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Part 162 - Administrative Requirements |
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Subpart L - Eligibility for a Health Plan |
§ 162.1201 - Eligibility for a health plan transaction.
Latest version.
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§ 162.1201 Eligibility for a health plan transaction.
The eligibility for a health plan transaction is the transmission of either of the following:
(a) An inquiry from a health care provider to a health plan, or from one health plan to another health plan, to obtain any of the following information about a benefit plan for an enrollee:
(1) Eligibility to receive health care under the health plan.
(2) Coverage of health care under the health plan.
(3) Benefits associated with the benefit plan.
(b) A response from a health plan to a health care provider's (or another health plan's) inquiry described in paragraph (a) of this section.