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.
[74 FR 3326, Jan. 16, 2009]