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Title 45Subtitle ASubchapter C → Part 162


Contents

Subpart A—General Provisions

§162.100   Applicability.
§162.103   Definitions.

Subparts B-C [Reserved]

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.

Subpart E—Standard Unique Health Identifier for Health Plans

§162.502   [Reserved]
§162.504   Compliance requirements for the implementation of the standard unique health plan identifier.
§162.506   Standard unique health plan identifier.
§162.508   Enumeration System.
§162.510   Full implementation requirements: Covered entities.
§162.512   Implementation specifications: Health plans.
§162.514   Other entity identifier.

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.

Subparts G-H [Reserved]

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.

Subpart J—Code Sets

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

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.

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.

Subpart M—Referral Certification and Authorization

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

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.

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.

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.

Subpart Q—Health Plan Premium Payments

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

Subpart R—Coordination of Benefits

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

Subpart S—Medicaid Pharmacy Subrogation

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