What are covered transactions?
A covered transaction is any computer-to-computer transmission of healthcare claims, payment and remittance, benefit information, or health plan eligibility information. The covered transactions most commonly used by clinicians include Health Care Claims (request for reimbursement by a provider to a health plan for health care services); Eligibility for Treatment (request for information by a provider to a health plan about eligibility, coverage limits, and/or benefits in a health plan for a client or potential client); Authorization for Treatment (request made to a health plan for authorization of mental health treatment by a mental health provider); and Health Care Claims Status (request by a mental health provider to a health care plan).
