45 CFR 162.1201
§ 162.1201 Eligibility for a health plan transaction.
United States · 45 CFR — Public Welfare · Status: effective
Cite this
- Citation
- 45 CFR 162.1201, § 162.1201 Eligibility for a health plan transaction, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/218026
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Full text
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.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.