Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.
Group code
CO, PI or PR
Category
Benefit Maximum/Limitation
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 254 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
See the full resolution workflow for CARC 254
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every CARC and RARC pairing, plus payer-specific quirks.
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