{"data":{"id":"us/45-cfr-162.1101","jurisdiction":"us","citation":"45 CFR 162.1101","heading":"Health care claims or equivalent encounter information transaction.","body":"The health care claims or equivalent encounter information transaction is the transmission of either of the following:\n(a) A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care.\n(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.","path":["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"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-45.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:21Z","sha256":"75d942044be18de3b8c654da4b7932bf5b3991e9cc926cdb31f9a2d7218b2ca6","source_id":"us-cfr","stale":true,"prev":"us/45-cfr-162.1011","next":"us/45-cfr-162.1102"},"notice":"GroundRules: Original legal text. Not legal advice."}