['Employee Benefits']

['HIPAA privacy and security']

12/06/2023

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§162.1101 Health care claims or equivalent encounter information transaction.

...

§162.1101 Health care claims or equivalent encounter information transaction.

RegSense HIPAA privacy and security Employee Benefits CFR Regulations Associate Benefits & Compensation CFR Section Focus Area Human Resources

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.

['Employee Benefits']

['HIPAA privacy and security']

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