Common Dental Claim Rejection Codes and What They Mean

Dental billing specialists know that claim rejections and denials are an inevitable part of the revenue cycle. Understanding the specific codes and reasons behind these rejections—especially from major payers like Delta Dental—can make the difference between delayed payments and a healthy accounts receivable (AR). This guide decodes common dental insurance rejection codes, focusing on actionable steps to resolve and prevent them.

Understanding Claim Adjustment/Denial Codes

When a dental claim is processed, the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) will include adjustment or denial codes. These codes, such as Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs), provide the payer’s rationale for partial payment, denial, or rejection.

Key points to remember:

• CARCs indicate why a claim or service line was paid differently than billed (e.g., not covered, missing information).
• RARCs offer additional context or clarification for the adjustment.
• Delta Dental uses proprietary codes in addition to standard codes, so always refer to their code lists when reviewing EOBs.

Accurate interpretation of these codes is essential for timely claim corrections and appeals.

Frequent Delta Dental Denial Codes Explained

Delta Dental, as one of the largest dental insurers, has specific rejection codes that practices encounter frequently. Here are some of the most common:

• Code 201 – Missing/Invalid Information: Indicates incomplete or incorrect patient, provider, or service details. Double-check CDT codes, dates of service, and subscriber information.
• Code 203 – Service Not Covered: The procedure billed is not a covered benefit under the patient’s plan. Review the patient’s eligibility and benefits before treatment.
• Code 222 – Frequency Limitation Exceeded: The procedure has already been performed within the plan’s allowed frequency (e.g., two cleanings per year).
• Code 234 – Waiting Period Not Met: The patient has not yet satisfied the required waiting period for the procedure.
• Code 289 – Coordination of Benefits (COB) Required: Delta Dental needs information about other insurance coverage before processing the claim.

Understanding these codes helps billing teams quickly identify the root cause of denials and take corrective action.

How to Respond to Specific Rejection Reasons

Efficient response to claim rejections is critical for maintaining cash flow. Here’s how to address the most common Delta Dental denial scenarios:

• Missing/Invalid Information (Code 201): Review the EOB for specifics, correct errors in patient demographics, provider NPI, or CDT codes, and resubmit the claim promptly.
• Service Not Covered (Code 203): Verify the patient’s benefits and discuss alternative treatment options or payment arrangements if the service is truly not covered.
• Frequency Limitation Exceeded (Code 222): Check the patient’s treatment history and, if appropriate, submit documentation supporting medical necessity for exceptions.
• Waiting Period Not Met (Code 234): Inform the patient and schedule the procedure for a date after the waiting period expires.
• COB Required (Code 289): Collect and submit the necessary primary insurance EOB or COB information to Delta Dental.

For all denials, document your actions in the patient’s record and track the claim’s status until resolution. If a claim is denied in error, prepare a detailed appeal with supporting documentation.

Preventing Rejections: Tips for Clean Claims

Proactive steps can significantly reduce claim rejections and denials. Best practices include:

• Insurance Verification: Verify eligibility, coverage, and plan limitations before every appointment.
• Accurate Coding: Use current CDT codes and ensure all required fields are completed accurately.
• Documentation: Attach necessary clinical notes, radiographs, and narratives for procedures likely to be questioned.
• Timely Submission: Submit claims promptly and track them using your practice management software.
• Staff Training: Regularly train billing and front office staff on payer-specific requirements and updates.

By implementing these strategies, dental practices can minimize denials, improve AR, and ensure a smoother revenue cycle.