45 C.F.R. § 162.1101 Health care claims or equivalent encounter information transaction.
Title 45 - Public Welfare
The health care claims or equivalent encounter information transaction is the transmission of either of the following: (a) A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care. (b) 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.
Title 45: Public Welfare
PART 162—ADMINISTRATIVE REQUIREMENTS
Subpart K—Health Care Claims or Equivalent Encounter Information
§ 162.1101 Health care claims or equivalent encounter information transaction.
