CARC Code
168
Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.
How to resolve this denial
Submit claim to the medical plan; dental plan does not cover this service
- 1
Pull the original claim and review the denial reason and any RARC codes
- 2
Research the payer's policy for CARC 168 to understand the basis for denial
- 3
Gather supporting documentation addressing the denial reason
- 4
Submit a formal appeal with the documentation within the plan's appeal window
- 5
Follow up on the appeal within 30 days and document all communication
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about CO-168 — stats, related codes, appeal template
55%
Recovery Rate
14-30 days
Avg. Resolution
Medium
Difficulty
Occasional
Frequency
Payer-Specific Notes
How major payers handle CARC 168 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Appeal Letter Template
Generic appeal template for CARC 168 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 168 indicating: "Service considered under patient's medical plan. Not covered under dental plan.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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