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Referral certification and authorization transaction.

45 CFR § 162.1301

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45 CFR § 162.1301

45 CFR § 162.1301

Referral certification and authorization transaction. The referral certification and authorization transaction is any of the following transmissions:

(a)

A request from a health care provider to a health plan for the review of health care to obtain an authorization for the health care.

(b)

A request from a health care provider to a health plan to obtain authorization for referring an individual to another health care provider.

(c)

A response from a health plan to a health care provider to a request described in paragraph (a) or paragraph (b) of this section.