45 C.F.R. Subpart P—Health Care Payment and Remittance Advice
Title 45 - Public Welfare
The health care payment and remittance advice transaction is the transmission of either of the following for health care: (a) The transmission of any of the following from a health plan to a health care provider's financial institution: (1) Payment. (2) Information about the transfer of funds. (3) Payment processing information. (b) The transmission of either of the following from a health plan to a health care provider: (1) Explanation of benefits. (2) Remittance advice. The Secretary adopts the following standards for the health care payment and remittance advice transaction. (a) For the period from October 16, 2002 through October 15, 2003: (1) Retail pharmacy drug claims and remittance advice. The NCPDP Telecommunication Standard Implementation Guide, Version 5 Release 1, September 1999, and equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1 Release 0, February 1, 1996. (Incorporated by reference in §162.920). (2) Dental, professional, and institutional health care claims and remittance advice. The ASC X12N 835—Health Care Claim Payment/Advice, Version 4010, May 2000, Washington Publishing Company, 004010X091. (Incorporated by reference in §162.920). (b) For the period on and after October 16, 2003: Health care claims and remittance advice. The ASC X12N 835—Health Care Claim Payment/Advice, Version 4010, May 2000, Washington Publishing Company, 004010X091, and Addenda to Health Care Claim Payment/Advice, Version 4010, October 2002, Washington Publishing Company, 004010X091A1. (Incorporated by reference in §162.920). [68 FR 8398, Feb. 20, 2003]
Title 45: Public Welfare
PART 162—ADMINISTRATIVE REQUIREMENTS
Subpart P—Health Care Payment and Remittance Advice
§ 162.1601 Health care payment and remittance advice transaction.
§ 162.1602 Standards for health care payment and remittance advice transaction.
