§162.1101. Health care claims or equivalent encounter information transaction.
45 C.F.R. § 162.1101
The health care claims or equivalent encounter information transaction is the transmission of either of the following:
A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care.
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.
Notes, amendments, and revision history
Authority
Authority: 42 U.S.C. 1320d—1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917.
Source
Source: 65 FR 50367, Aug. 17, 2000, unless otherwise noted.