GroundRules
45 CFR 162.1101: Health care claims or equivalent encounter information transaction.
Where this section sits in the code
- Title 45—Public Welfare
- SUBTITLE A—Department of Health and Human Services
- SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS
- PART 162—ADMINISTRATIVE REQUIREMENTS
- Subpart K—Health Care Claims or Equivalent Encounter Information
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.
Collected 2026-08-27T02:26:21Z. Source file · JSON