{"data":{"id":"us/45-cfr-162.1201","jurisdiction":"us","citation":"45 CFR 162.1201","heading":"Eligibility for a health plan transaction.","body":"The eligibility for a health plan transaction is the transmission of either of the following:\n(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:\n(1) Eligibility to receive health care under the health plan.\n(2) Coverage of health care under the health plan.\n(3) Benefits associated with the benefit plan.\n(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.","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 L—Eligibility for a Health Plan"],"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":"400135fa1e634ffdc07ddc5f9e3b71b179adf72d4507944b94d18f29d7746d0a","source_id":"us-cfr","stale":true,"prev":"us/45-cfr-162.1102","next":"us/45-cfr-162.1202"},"notice":"GroundRules: Original legal text. Not legal advice."}