45 C.F.R. Subpart M—Referral Certification and Authorization
Title 45 - Public Welfare
The referral certification and authorization transaction is any of the following transmissions: (a) A request for the review of health care to obtain an authorization for the health care. (b) A request to obtain authorization for referring an individual to another health care provider. (c) A response to a request described in paragraph (a) or paragraph (b) of this section. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For the period from October 16, 2002, through October 15, 2003: The ASC X12N 278—Health Care Services Review—Request for Review and Response, Version 4010, May 2000, Washington Publishing Company, 004010X094. (Incorporated by reference in §162.920). (b) For the period on and after October 16, 2003: (1) Retail pharmacy drug referral certification and authorization. The NCPDP Telecommunication Standard Implementation Guide, Version 5, Release 1 (Version 5.1), September 1999, and equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1, Release 1 (Version 1.1), January 2000, supporting Telecommunications Standard Implementation Guide, Version 5, Release 1 (Version 5.1) for the NCPDP Data Record in the Detail Data Record. (Incorporated by reference in §162.920). (2) Dental, professional, and institutional referral certification and authorization. The ASC X12N 278—Health Care Services Review—Request for Review and Response, Version 4010, May 2000, Washington Publishing Company, 004010X094 and Addenda to Health Care Services Review—Request for Review and Response, Version 4010, October 2002, Washington Publishing Company, 004010X094A1. (Incorporated by reference in §162.920). [68 FR 8398, Feb. 20, 2003]
Title 45: Public Welfare
PART 162—ADMINISTRATIVE REQUIREMENTS
Subpart M—Referral Certification and Authorization
§ 162.1301 Referral certification and authorization transaction.
§ 162.1302 Standards for referral certification and authorization transaction.