Section 162.1201 - Eligibility for a health plan transactionThe eligibility for a health plan transaction is the transmission of either of the following:
(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) Eligibility to receive health care under the health plan.(2) Coverage of health care under the health plan.(3) Benefits associated with the benefit plan.(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.