GroundRules
45 CFR 162.1301: Referral certification and authorization 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 M—Referral Certification and Authorization
The referral certification and authorization transaction is any of the following transmissions:
(a) A request from a health care provider to a health plan for the review of health care to obtain an authorization for the health care.
(b) A request from a health care provider to a health plan to obtain authorization for referring an individual to another health care provider.
(c) A response from a health plan to a health care provider to a request described in paragraph (a) or paragraph (b) of this section.
Collected 2026-08-27T02:26:21Z. Source file · JSON