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Why didn't this dental claim pay?

Type the codes from one line of an EOB. We tell you who owes the money, why the claim paid short, and what to do next. It's free!

Codes only. Never paste patient or claim information.

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After the code

Autumn works the whole claim.

This tool reads one line. Autumn tracks every claim to the payer, posts the EOB line by line against the ledger, and drafts the appeal when a claim is denied.

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Three codes, three different jobs

Every EOB line carries up to three codes. They answer different questions, and teams lose time when the three get read as one.

CAGC Claim adjustment group code
Two letters: CO, PR, OA, PI, or CR. Says who the payer put the money on. Never says the payer got it right.
CARC Claim adjustment reason code
A number, such as 16 or 119. Says why you were paid less than you billed.
RARC Remittance advice remark code
Starts with N, M, or MA, such as N37. Adds the detail. In dentistry that is usually a tooth, a surface, or a date.

What this tool will not do

It explains the code the payer sent. It does not decide coverage, and it does not replace the plan document, the provider contract, the chart, or the payer's own instructions. Many payers also print their own codes beside the standard ones.

We cover a reviewed set of dental codes. If a code is payer-specific or we have not reviewed it, the tool says so instead of guessing. The published X12 list and the full payer response always win.

Sources

Keep reading: how to post a dental insurance adjustment and how to appeal a dental claim denial.