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Covered Transactions

Date of Publication:

8/12/2015

Definition:

The transactions covered by this instruction are the transmission of information between two parties to carry out financial or administrative activities related to health care, including: 

  • Health care claims or equivalent encounter information.
  • Health care payment and remittance advice.
  • Coordination of benefits. 
  • Health care claim status. 
  • Enrollment or disenrollment in a health plan. 
  • Eligibility for a health plan. 
  • Health plan premium payments. 
  • Referral certification and authorization. 
  • First report of injury. 
  • Health claims attachments. 
  • Other transactions that the Secretary of the Department of Health and Human Services may prescribe by regulation.

Source of Definition:

Security of Individually Identifiable Health Information in DoD Health Care Programs

Last Updated: December 09, 2022
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