Page:United States Statutes at Large Volume 115 Part 1.djvu/1028

 115 STAT. 1006 PUBLIC LAW 107-105—DEC. 27, 2001 treated as a health care clearinghouse without regard to whether the processing or facilitation produces (or is required to produce) standard data elements or a standard transaction as required by part 162 of title 45, Code of Federal Regulations. (C) TRANSACTIONS DESCRIBED.—The transactions described in this subparagraph are the following: (i) A health care claims or equivalent encounter information transaction. (ii) A health care payment and remittance advice transaction. (iii) A coordination of benefits transaction, (iv) A health care claim status transaction. (v) An enrollment and disenrollment in a health plan transaction. (vi) An eligibility for a health plan transaction, (vii) A health plan premium pa3anents transaction, (viii) A referral certification and authorization transaction, (c) DEFINITIONS. —In this section— (1) the terms "health care provider", "health plan", and "health care clearinghouse" have the meaning given those terms in section 1171 of the Social Security Act (42 U.S.C. 1320d) and section 160.103 of title 45, Code of Federal Regulations; (2) the terms "small health plan" and "tr8insaction" have the meaning given those terms in section 160.103 of title 45, Code of Federal Regulations; and (3) the terms "heedth care cledms or equivalent encounter information transaction", "health care payment and remittance advice transaction", "coordination of benefits transaction", "health care claim status transaction", "enrollment and disenrollment in a health plan transaction", "eligibility for a health plan trguisaction", "health plan premium payments transaction", and "referral certification and authorization transaction" have the meanings given those terms in sections 162.1101, 162.1601, 162.1801, 162.1401, 162.1501, 162.1201, 162.1701, and 162.1301 of title 45, Code of Federal Regulations, respectively. SEC. 3. REQUIRING ELECTRONIC SUBMISSION OF MEDICARE CLAIMS. (a) IN GENERAL. —Section 1862 of the Social Security Act (42 U.S.C. 1395y) is amended— (1) in subsection (a)— (A) by striking "or" at the end of paragraph (20); (B) by striking the period at the end of psiragraph (21) and inserting "; or"; and (C) by inserting after paragraph (21) the following new paragraph: "(22) subject to subsection (h), for which a claim is submitted other than in an electronic form specified by the Secretary."; and (2) by inserting after subsection (g) the following new subsection: "(h)(1) The Secretary— "(A) shall waive the application of subsection (a)(22) in cases in which—

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