45 CFR 162.1101
§ 162.1101 Health care claims or equivalent encounter information transaction.
United States · 45 CFR — Public Welfare · Status: effective
Cite this
- Citation
- 45 CFR 162.1101, § 162.1101 Health care claims or equivalent encounter information transaction, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/218023
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Full text
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.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.