C.F.R. » Title 45 » SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS › PART 162—ADMINISTRATIVE REQUIREMENTS › Subpart K—Health Care Claims or Equivalent Encounter Information

45 C.F.R. § 162.1101

Health care claims or equivalent encounter information transaction

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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.

Notes of Decisions
Cited in 1 case, 2015–2015 · leading case: United States ex rel. Garbe v. Kmart Corp., 73 F. Supp. 3d 1002 (S.D. Ill. 2015).
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United States ex rel. Garbe v. Kmart Corp., 73 F. Supp. 3d 1002 (S.D. Ill. 2015). “See 45 C.F.R. §§ 162.1101 (a), 160.103; Thulin v.”
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