StacksVerified U.S. regulatory reference

45 CFR §162.1101

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The health care claims or equivalent encounter information transaction is the transmission of either of the following:
  1. (a)A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care.
  2. (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.