(a) Corresponde a un servicio de salud prestado por un proveedor a una persona asegurada por cuyo servicio está cubierto por un seguro de salud o plan de cuidado de salud del asegurador u organización de servicios de salud al cual se dirige la reclamación;
(b) incluye la información completa y correcta requerida por el asegurador u organización de servicios de salud siempre y cuando el asegurador u organización de salud haya notificado al proveedor participante la información requerida, y
(c) no hay disputa en cuanto a la cantidad reclamada.
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