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Dentovio public answer
On a dental remittance, CARC 96 means: The plan did not allow this charge.
On a dental remittance, CARC 96 means: The plan did not allow this charge. The code's own definition requires an accompanying remark code, so the coverage reason should always be on the remittance. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. Remark codes verified with it: N54. Dentovio's appealability verdict — structural: verify the plan terms. If the plan genuinely excludes the service, the contract controls. Review it when the exclusion may have been misapplied — for example, a missing-tooth clause applied to a tooth extracted during coverage — and use records to establish the disputed fact.
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. 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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