Prior Auth Required

2110C - For 271 response transactions, Care4Kids enrollment will be identified in the EB segment of the loop. Identified by "MC"

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceFor 271 response transactions, Care4Kids enrollment will be identified in the EB segment of the loop. Identified by "MC"
Procedure / Service Description

Providers should verify a member's enrollment before providing services to determine if the member is enrolled in Care4Kids. - Care Enrollment panel. For 271 response transactions, Care4Kids enrollment will be identified in the EB segment of the 2110C loop. Identified by "MC" in the EB01, "HM" in the EB04, and "Care4Kids" in the EB05. The MC provider contact information will be reported in the NM1 (name info), N3 (address info), and PER (telephone numbers) segments within the 2120C loop.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.