Title 45

PART 162

Part 162 - Administrative Requirements

PART 162 - ADMINISTRATIVE REQUIREMENTS Authority:42 U.S.C. 1320d - 1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917. Source:65 FR 50367, Aug. 17, 2000, unless otherwise noted.

45:2.0.1.2.19.1SUBPART A
Subpart A - General Provisions
45:2.0.1.2.19.1.1.1SECTION 162.100
   162.100 Applicability.
45:2.0.1.2.19.1.1.2SECTION 162.103
   162.103 Definitions.
45:2.0.1.2.19.2SUBPART B
Subparts B-C [Reserved]
45:2.0.1.2.19.3SUBPART D
Subpart D - Standard Unique Health Identifier for Health Care Providers
45:2.0.1.2.19.3.1.1SECTION 162.402
   162.402 [Reserved]
45:2.0.1.2.19.3.1.2SECTION 162.404
   162.404 Compliance dates of the implementation of the standard unique health identifier for health care providers.
45:2.0.1.2.19.3.1.3SECTION 162.406
   162.406 Standard unique health identifier for health care providers.
45:2.0.1.2.19.3.1.4SECTION 162.408
   162.408 National Provider System.
45:2.0.1.2.19.3.1.5SECTION 162.410
   162.410 Implementation specifications: Health care providers.
45:2.0.1.2.19.3.1.6SECTION 162.412
   162.412 Implementation specifications: Health plans.
45:2.0.1.2.19.3.1.7SECTION 162.414
   162.414 Implementation specifications: Health care clearinghouses.
45:2.0.1.2.19.4SUBPART E
Subpart E [Reserved]
45:2.0.1.2.19.5SUBPART F
Subpart F - Standard Unique Employer Identifier
45:2.0.1.2.19.5.1.1SECTION 162.600
   162.600 Compliance dates of the implementation of the standard unique employer identifier.
45:2.0.1.2.19.5.1.2SECTION 162.605
   162.605 Standard unique employer identifier.
45:2.0.1.2.19.5.1.3SECTION 162.610
   162.610 Implementation specifications for covered entities.
45:2.0.1.2.19.6SUBPART G
Subparts G-H [Reserved]
45:2.0.1.2.19.7SUBPART I
Subpart I - General Provisions for Transactions
45:2.0.1.2.19.7.1.1SECTION 162.900
   162.900 [Reserved]
45:2.0.1.2.19.7.1.2SECTION 162.910
   162.910 Maintenance of standards and adoption of modifications and new standards.
45:2.0.1.2.19.7.1.3SECTION 162.915
   162.915 Trading partner agreements.
45:2.0.1.2.19.7.1.4SECTION 162.920
   162.920 Availability of implementation specifications and operating rules.
45:2.0.1.2.19.7.1.5SECTION 162.923
   162.923 Requirements for covered entities.
45:2.0.1.2.19.7.1.6SECTION 162.925
   162.925 Additional requirements for health plans.
45:2.0.1.2.19.7.1.7SECTION 162.930
   162.930 Additional rules for health care clearinghouses.
45:2.0.1.2.19.7.1.8SECTION 162.940
   162.940 Exceptions from standards to permit testing of proposed modifications.
45:2.0.1.2.19.8SUBPART J
Subpart J - Code Sets
45:2.0.1.2.19.8.1.1SECTION 162.1000
   162.1000 General requirements.
45:2.0.1.2.19.8.1.2SECTION 162.1002
   162.1002 Medical data code sets.
45:2.0.1.2.19.8.1.3SECTION 162.1011
   162.1011 Valid code sets.
45:2.0.1.2.19.9SUBPART K
Subpart K - Health Care Claims or Equivalent Encounter Information
45:2.0.1.2.19.9.1.1SECTION 162.1101
   162.1101 Health care claims or equivalent encounter information transaction.
45:2.0.1.2.19.9.1.2SECTION 162.1102
   162.1102 Standards for health care claims or equivalent encounter information transaction.
45:2.0.1.2.19.10SUBPART L
Subpart L - Eligibility for a Health Plan
45:2.0.1.2.19.10.1.1SECTION 162.1201
   162.1201 Eligibility for a health plan transaction.
45:2.0.1.2.19.10.1.2SECTION 162.1202
   162.1202 Standards for eligibility for a health plan transaction.
45:2.0.1.2.19.10.1.3SECTION 162.1203
   162.1203 Operating rules for eligibility for a health plan transaction.
45:2.0.1.2.19.11SUBPART M
Subpart M - Referral Certification and Authorization
45:2.0.1.2.19.11.1.1SECTION 162.1301
   162.1301 Referral certification and authorization transaction.
45:2.0.1.2.19.11.1.2SECTION 162.1302
   162.1302 Standards for referral certification and authorization transaction.
45:2.0.1.2.19.12SUBPART N
Subpart N - Health Care Claim Status
45:2.0.1.2.19.12.1.1SECTION 162.1401
   162.1401 Health care claim status transaction.
45:2.0.1.2.19.12.1.2SECTION 162.1402
   162.1402 Standards for health care claim status transaction.
45:2.0.1.2.19.12.1.3SECTION 162.1403
   162.1403 Operating rules for health care claim status transaction.
45:2.0.1.2.19.13SUBPART O
Subpart O - Enrollment and Disenrollment in a Health Plan
45:2.0.1.2.19.13.1.1SECTION 162.1501
   162.1501 Enrollment and disenrollment in a health plan transaction.
45:2.0.1.2.19.13.1.2SECTION 162.1502
   162.1502 Standards for enrollment and disenrollment in a health plan transaction.
45:2.0.1.2.19.14SUBPART P
Subpart P - Health Care Electronic Funds Transfers (EFT) and Remittance Advice
45:2.0.1.2.19.14.1.1SECTION 162.1601
   162.1601 Health care electronic funds transfers (EFT) and remittance advice transaction.
45:2.0.1.2.19.14.1.2SECTION 162.1602
   162.1602 Standards for health care electronic funds transfers (EFT) and remittance advice transaction.
45:2.0.1.2.19.14.1.3SECTION 162.1603
   162.1603 Operating rules for health care electronic funds transfers (EFT) and remittance advice transaction.
45:2.0.1.2.19.15SUBPART Q
Subpart Q - Health Plan Premium Payments
45:2.0.1.2.19.15.1.1SECTION 162.1701
   162.1701 Health plan premium payments transaction.
45:2.0.1.2.19.15.1.2SECTION 162.1702
   162.1702 Standards for health plan premium payments transaction.
45:2.0.1.2.19.16SUBPART R
Subpart R - Coordination of Benefits
45:2.0.1.2.19.16.1.1SECTION 162.1801
   162.1801 Coordination of benefits transaction.
45:2.0.1.2.19.16.1.2SECTION 162.1802
   162.1802 Standards for coordination of benefits information transaction.
45:2.0.1.2.19.17SUBPART S
Subpart S - Medicaid Pharmacy Subrogation
45:2.0.1.2.19.17.1.1SECTION 162.1901
   162.1901 Medicaid pharmacy subrogation transaction.
45:2.0.1.2.19.17.1.2SECTION 162.1902
   162.1902 Standard for Medicaid pharmacy subrogation transaction.