Dentovio public answer
CARC 252 denial code dental
On a dental remittance, CARC 252 means: The payer cannot finish adjudicating without documentation it has not received, and must name what is missing in an accompanying remark code.
Sourced answer
On a dental remittance, CARC 252 means: The payer cannot finish adjudicating without documentation it has not received, and must name what is missing in an accompanying remark code. X12 restricts its group code to CO or PI. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. Remark codes verified with it: N401, N706, N928, N931. Dentovio's appealability verdict — technical: fix and resubmit. Send what was asked for rather than arguing the decision. Work from the payer's own published documentation requirements for the procedure so the resubmission cannot be judged deficient a second time, and watch the response window — leaving the request unanswered turns a 252 into a 226.
- Cluster
- Practice operations
- Last verified
- 2026-08-30
- Reviewer
- None — owner-published
Dentovio is an independent publisher — not a payer, the ADA, X12, CAQH CORE, or any government agency. Code meanings and remark-code meanings on this page are Dentovio's own wording, written from the official X12 Claim Adjustment Reason Code and Remittance Advice Remark Code lists and linked back to them; X12 holds the copyright in those lists and its descriptions are not reproduced here. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors. Appealability verdicts are Dentovio editorial classification, not a standard. Every fact traces to the code steward's registry, a federal rule or manual, a HIPAA operating rule, an association publication, or a named payer's own document — never to a billing blog. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist, attorney, or clinician. Educational billing reference only — not billing, legal, or clinical advice. Plan contracts control individual outcomes, and processing policies usually live in the payer's provider manual rather than in the signed agreement.
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Source citations
- X12-CARC X12 Claim Adjustment Reason Codes (official list) (x12.org)
- ECFR-ERISA-CLAIMS 29 CFR 2560.503-1 — ERISA claims procedure (ecfr.gov)
- ECFR-MEDICAID-APPEALS 42 CFR 438.402 — Medicaid managed-care appeal framework (ecfr.gov)
- ECFR-MEDICAID-TIMING 42 CFR 438.408 — Medicaid managed-care appeal timing (ecfr.gov)
- DENIAL-EVIDENCE-252-1 CAQH CORE-required Code Combinations for CORE-defined Business Scenarios, v3.10.0, February 2026 (dataspring.com)
- DENIAL-EVIDENCE-252-2 New York State Medicaid Dental Policy and Procedure Code Manual, Version 2026 (effective 2026-01-01) (emedny.org)