StacksVerified U.S. regulatory reference

45 CFR §162.1201

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The eligibility for a health plan transaction is the transmission of either of the following:
  1. (a)An inquiry from a health care provider to a health plan, or from one health plan to another health plan, to obtain any of the following information about a benefit plan for an enrollee:
    1. (1)Eligibility to receive health care under the health plan.
    2. (2)Coverage of health care under the health plan.
    3. (3)Benefits associated with the benefit plan.
  2. (b)A response from a health plan to a health care provider's (or another health plan's) inquiry described in paragraph (a) of this section.