What does denial code CARC 226 mean on a dental claim, and can it be appealed?

On a dental remittance, CARC 226 means: The payer asked the billing or rendering provider for information and never got a usable answer — nothing arrived, it arrived too late, or what arrived did not cover the question. Like 252, its own definition requires an accompanying remark code. 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. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — depends: check the facts first. Whether the information can still be supplied is a payer-contract question, not something the code answers. Find the original request, establish what was sent and when, and ask the payer in writing what window remains before treating the balance as final.

Attachments and requested documentation · Last verified 2026-08-30

CARC 226 denial code on dental claims

Independent publisher · Drafted with AI assistance, verified against primary sources · Credentialed review pending

CARC 226 is the “Provider never answered” code on a dental remittance. Whether it can be contested depends on the facts; run the checks below first.

Group code: 226 appears nowhere in the CAQH CORE code-combination workbook — not in the master sheet and not in any business scenario — so no operating rule fixes its group code. The payer chooses. A group code always travels with a CARC, and it — not the CARC — assigns financial responsibility, so read the one on your remittance rather than assuming.

Registry entry: X12 Claim Adjustment Reason Code 226 — in the code set since 2008-09-21; description last revised 2013-07-01; active, with no deactivation date. Read on the list published 2025-11-01.

Remark code required:this code's own definition requires one, so a remittance carrying it without a remark code is incomplete.

Verdict

Depends — check the facts first

A valid contract term may control, while a factual error may be contested. Run the checks on this page before using the appeal window.

Whether the information can still be supplied is a payer-contract question, not something the code answers. Find the original request, establish what was sent and when, and ask the payer in writing what window remains before treating the balance as final.

The appealability verdicts on these pages are Dentovio's editorial classification. No standards body or payer publishes an appealability taxonomy: X12 defines what a code means, not what to do about it. Each verdict is built from the code's own mechanics and the payer and federal documents cited on the page, and it is a starting point for triage rather than a prediction of any outcome.

What it means in dental

The payer asked the billing or rendering provider for information and never got a usable answer — nothing arrived, it arrived too late, or what arrived did not cover the question. Like 252, its own definition requires an accompanying remark code.

This is the end state of an unanswered documentation request, and it is the provider-side code — the member-side counterpart is 227. It sits outside the CAQH CORE combination list entirely, which means there is no standard-mandated group code for it and no standard remark pairing, whatever a code guide asserts.

What to do

1.Trace the original information request and whatever the office sent in response
2.Ask the payer in writing what response window applies and whether it has closed
3.Fix the intake side: an unanswered request is usually a mail or portal-routing failure, not a clinical one

Remark codes verified with this CARC

No source read for this page pairs a remark code with CARC 226. X12 defines no CARC-to-RARC pairings at all: payer crosswalks are specific to that payer's own internal reason codes, and the CAQH CORE combination list binds only payers operating inside its business scenarios. Read the remark code on your own remittance.

Appeal routes, by plan funding

Fully-insured route

State insurance law (prompt-pay statutes + plan appeal terms)

Check the state's prompt-pay rule first — an overdue clean claim may already be accruing interest without any appeal. Then run the policy's internal appeal, and escalate to the state insurance department where deadlines were missed.

Self-funded (ERISA) route

29 CFR 2560.503-1

Appeal in the patient's name (or with an authorized-representative form), demand the claim file and the specific internal rule relied on, and hold the plan to the 30/60-day clocks in writing. Before counting on a state remedy, read that state's own scope provision: several state prompt-pay and external-review statutes reach only insurers and HMOs by their terms, so they do not extend to a self-funded plan.

Medicaid managed care route

42 CFR 438.402 / 438.408

First classify the dispute. For an enrollee benefit denial, track two clocks in order: 60 days to the plan appeal, then (after the resolution notice) the state's 90–120-day fair-hearing window, with written consent before a provider acts for the enrollee. For a provider payment or contract dispute, use the provider contract and state Medicaid program process instead. For members under 21, federal EPSDT coverage rules also matter.

Read with this code

Sources

X12 Claim Adjustment Reason Codes (external code list 139) — list updated 2025-11-01
X12 Remittance Advice Remark Codes (external code list 411) — list updated 2026-07-01
45 CFR 162.1602 — HIPAA adoption of the 835 remittance standard that carries these codes
CAQH CORE-required Code Combinations for CORE-defined Business Scenarios, v3.10.0, February 2026 — Master sheet and Business Scenario #1