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CFR › Title 45 › Subtitle A › Subchapter C › Part 162 › Subpart L › Section 162.1202

45 CFR 162.1202 - Standards for eligibility for a health plan transaction.

There is 1 rule appearing in the Federal Register for 45 CFR 162. Select the tab below to view, or View eCFR (GPOAccess)
§ 162.1202
Standards for eligibility for a health plan transaction.
The Secretary adopts the following standards for the eligibility for a health plan transaction:
(a) For the period from October 16, 2003 through March 16, 2009:
(1) Retail pharmacy drugs. The National Council for Prescription Drug Programs Telecommunication Standard Implementation Guide, Version 5, Release 1 (Version 5.1), September 1999, and equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1, Release 1 (Version 1.1), January 2000 supporting Telecommunications Standard Implementation Guide, Version 5, Release 1 (Version 5.1) for the NCPDP Data Record in the Detail Data Record. (Incorporated by reference in § 162.920 ).
(2) Dental, professional, and institutional health care eligibility benefit inquiry and response. The ASC X12N 270/271—Health Care Eligibility Benefit Inquiry and Response, Version 4010, May 2000, Washington Publishing Company, 004010X092 and Addenda to Health Care Eligibility Benefit Inquiry and Response, Version 4010, October 2002, Washington Publishing Company, 004010X092A1. (Incorporated by reference in § 162.920 ).
(b) For the period from March 17, 2009 through December 31, 2011 both:
(1) The standards identified in paragraph (a) of this section; and
(2) (i) Retail pharmacy drugs. The Telecommunication Standard Implementation Guide Version D, Release 0 (Version D.0), August 2007, and equivalent Batch Standard Implementation Guide, Version 1, Release 2 (Version 1.2), National Council for Prescription Drug Programs. (Incorporated by reference in § 162.920.)
(ii) Dental, professional, and institutional health care eligibility benefit inquiry and response. The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care Eligibility Benefit Inquiry and Response (270/271), April 2008, ASC X12N/005010X279. (Incorporated by reference in § 162.920.)
(c) For the period on and after January 1, 2012, the standards identified in paragraph (b)(2) of this section.
[68 FR 8398, Feb. 20, 2003; 68 FR 11445, Mar. 10, 2003, as amended at 74 FR 3326, Jan. 16, 2009]

Title 45 published on 2012-10-01

The following are only the Rules published in the Federal Register after the published date of Title 45.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2012-10-04; vol. 77 # 193 - Thursday, October 4, 2012
    1. 77 FR 60629 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets; Corrections
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Correction of final rule.
      Effective Date: November 5, 2012.
      45 CFR Part 162

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.

United States Code
U.S.C. : Title 42 - THE PUBLIC HEALTH AND WELFARE

§ 1320d - Definitions

42 USC § 1320d–1 - General requirements for adoption of standards

42 USC § 1320d–2 - Standards for information transactions and data elements

42 USC § 1320d–3 - Timetables for adoption of standards

42 USC § 1320d–4 - Requirements

42 USC § 1320d–5 - General penalty for failure to comply with requirements and standards

42 USC § 1320d–6 - Wrongful disclosure of individually identifiable health information

42 USC § 1320d–7 - Effect on State law

42 USC § 1320d–8 - Processing payment transactions by financial institutions

42 USC § 1320d–9 - Application of HIPAA regulations to genetic information

Title 45 published on 2012-10-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 45 CFR 162 after this date.

  • 2012-10-04; vol. 77 # 193 - Thursday, October 4, 2012
    1. 77 FR 60629 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets; Corrections
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Correction of final rule.
      Effective Date: November 5, 2012.
      45 CFR Part 162