[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR433.111]



[Page 90-91]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 433_STATE FISCAL ADMINISTRATION--Table of Contents

 

Subpart C_Mechanized Claims Processing and Information Retrieval Systems

 

Sec.  433.111  Definitions.



    For purposes of this section:

    (a) The following terms are defined at 45 CFR part 95, subpart F 

Sec.  95.605:



``Advance Planning Document''; ``Design'' or ``System Design''; 

``Development''; ``Enhancement''; ``Hardware''; ``Installation''; 

``Operation''; and, ``Software''.



    (b) ``Mechanized claims processing and information retrieval 

system'' or ``system'' means the system of software and hardware used to 

process



[[Page 91]]



Medicaid claims from providers of medical care and services for the 

medical care and services furnished to recipients under the medical 

assistance program and to retrieve and produce service utilization and 

management information required by the Medicaid single State agency and 

Federal Government for program administration and audit purposes. The 

system consists of

    (1) Required subsystems specified in the State Medicaid Manual;

    (2) Required changes to the required system or subsystem that are 

published in accordance with Sec.  433.123 of this subpart and specified 

in the State Medicaid Manual; and

    (3) Approved enhancements to the system. Eligibility determination 

systems are not part of mechanized claims processing and information 

retrieval systems or enhancements to those systems.



[51 FR 45330, Dec. 18, 1986, as amended at 54 FR 41973, Oct. 13, 1989]