| Name | Value |
|---|---|
| CODE | 254 |
| STATUS EFFECTIVE DATE |
|
| DESCRIPTION EFFECTIVE DATE |
|
| SUSPENSION DESCRIPTION | 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. |
| REMITTANCE REMARK |
|
| CORE SCENARIO | Billed Service Not Covered |
| ADJUSTMENT GROUP |
|