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

CARC 227 denial code on dental claims

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

CARC 227 is the “Patient never answered” code on a dental remittance. Whether it can be contested depends on the facts; run the checks below first.

Group code: X12 places no group-code restriction on 227. 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 227 — active, with no deactivation date. Read on the list published 2025-11-01.

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.

The office cannot supply what the payer asked the member for. The practical route is to reach the patient, get the form filed, and ask the payer to reprocess — with the timely-filing clock still running in the background.

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 patient, subscriber, or responsible party for information and did not get what it needed.

The distinction that matters: 226 means the office did not answer, 227 means the member did not. Coordination-of-benefits questionnaires, student-status forms, and other-coverage letters are the usual triggers, and the office often never learns the request was made. The remark code N179 belongs to the same member-side family — it says the payer has asked the member for information and will reconsider the charges on receipt, so any guide that reads N179 as the office owing documentation has it backwards.

What to do

  1. 1.Confirm what the payer asked the member for; the office is often not copied on the request
  2. 2.Contact the patient with the specific form or question, not a generic balance notice
  3. 3.Once the member responds, ask the payer to reprocess rather than refiling a duplicate claim

Remark codes verified with this CARC

X12 defines no CARC-to-RARC pairings. Each combination below is either a payer's own published crosswalk — true for that payer's internal reason code, not as a general rule — a CAQH CORE-required combination, or a remark whose registry meaning describes this adjustment.

N179 · Matches on the remark's registry meaning — no source pairs them

The payer has asked the member — not the office — for more information, and will look at the charges again when it arrives.

What to do: Prompt the patient to respond to the payer directly, then ask for reprocessing.

The registry text is explicit that the request went to the member. No combination list pairs it with 227; it is shown here because it describes the same member-side gap.

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

Last verified 2026-08-30. 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. How this data is verified