Prior Auth Required

2120C - NM1 (name info), N3 (address info), and PER (telephone numbers) segments within the loop

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceNM1 (name info), N3 (address info), and PER (telephone numbers) segments within the loop
Procedure / Service Description

Providers should verify a member's enrollment before providing services to determine if the member is enrolled in Care4Kids. - 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. The WiCall AVR (automated voice response) system will identify Care4Kids as the state-contracted managed care program in

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.