§162.1201. Eligibility for a health plan transaction.
45 C.F.R. § 162.1201
The eligibility for a health plan transaction is the transmission of either of the following:
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:
Eligibility to receive health care under the health plan.
Coverage of health care under the health plan.
Benefits associated with the benefit plan.
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.
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.