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Electronic Code of Federal Regulations

e-CFR data is current as of June 3, 2020

Title 45Subtitle ASubchapter CPart 162


TITLE 45—Public Welfare

Subtitle A—DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS

PART 162—ADMINISTRATIVE REQUIREMENTS

rule

Subpart A—GENERAL PROVISIONS

§162.100
Applicability.
§162.103
Definitions.
rule

Subparts B-C [Reserved]

rule

Subpart D—STANDARD UNIQUE HEALTH IDENTIFIER FOR HEALTH CARE PROVIDERS

§162.402
[Reserved]
§162.404
Compliance dates of the implementation of the standard unique health identifier for health care providers.
§162.406
Standard unique health identifier for health care providers.
§162.408
National Provider System.
§162.410
Implementation specifications: Health care providers.
§162.412
Implementation specifications: Health plans.
§162.414
Implementation specifications: Health care clearinghouses.
rule

Subpart E—[RESERVED]

rule

Subpart F—STANDARD UNIQUE EMPLOYER IDENTIFIER

§162.600
Compliance dates of the implementation of the standard unique employer identifier.
§162.605
Standard unique employer identifier.
§162.610
Implementation specifications for covered entities.
rule

Subparts G-H [Reserved]

rule

Subpart I—GENERAL PROVISIONS FOR TRANSACTIONS

§162.900
[Reserved]
§162.910
Maintenance of standards and adoption of modifications and new standards.
§162.915
Trading partner agreements.
§162.920
Availability of implementation specifications and operating rules.
§162.923
Requirements for covered entities.
§162.925
Additional requirements for health plans.
§162.930
Additional rules for health care clearinghouses.
§162.940
Exceptions from standards to permit testing of proposed modifications.
rule

Subpart J—CODE SETS

§162.1000
General requirements.
§162.1002
Medical data code sets.
§162.1011
Valid code sets.
rule

Subpart K—HEALTH CARE CLAIMS OR EQUIVALENT ENCOUNTER INFORMATION

§162.1101
Health care claims or equivalent encounter information transaction.
§162.1102
Standards for health care claims or equivalent encounter information transaction.
rule

Subpart L—ELIGIBILITY FOR A HEALTH PLAN

§162.1201
Eligibility for a health plan transaction.
§162.1202
Standards for eligibility for a health plan transaction.
§162.1203
Operating rules for eligibility for a health plan transaction.
rule

Subpart M—REFERRAL CERTIFICATION AND AUTHORIZATION

§162.1301
Referral certification and authorization transaction.
§162.1302
Standards for referral certification and authorization transaction.
rule

Subpart N—HEALTH CARE CLAIM STATUS

§162.1401
Health care claim status transaction.
§162.1402
Standards for health care claim status transaction.
§162.1403
Operating rules for health care claim status transaction.
rule

Subpart O—ENROLLMENT AND DISENROLLMENT IN A HEALTH PLAN

§162.1501
Enrollment and disenrollment in a health plan transaction.
§162.1502
Standards for enrollment and disenrollment in a health plan transaction.
rule

Subpart P—HEALTH CARE ELECTRONIC FUNDS TRANSFERS (EFT) AND REMITTANCE ADVICE

§162.1601
Health care electronic funds transfers (EFT) and remittance advice transaction.
§162.1602
Standards for health care electronic funds transfers (EFT) and remittance advice transaction.
§162.1603
Operating rules for health care electronic funds transfers (EFT) and remittance advice transaction.
rule

Subpart Q—HEALTH PLAN PREMIUM PAYMENTS

§162.1701
Health plan premium payments transaction.
§162.1702
Standards for health plan premium payments transaction.
rule

Subpart R—COORDINATION OF BENEFITS

§162.1801
Coordination of benefits transaction.
§162.1802
Standards for coordination of benefits information transaction.
rule

Subpart S—MEDICAID PHARMACY SUBROGATION

§162.1901
Medicaid pharmacy subrogation transaction.
§162.1902
Standard for Medicaid pharmacy subrogation transaction.

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