GroundRules
45 CFR 162.1201: Eligibility for a health plan 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 L—Eligibility for a Health Plan
The eligibility for a health plan transaction is the transmission of either of the following:
(a) 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:
(1) Eligibility to receive health care under the health plan.
(2) Coverage of health care under the health plan.
(3) Benefits associated with the benefit plan.
(b) 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.
Collected 2026-08-27T02:26:21Z. Source file · JSON