CO-270: Medical Plan Benefits Not Available - Submit to Dental
CO-270 means the medical plan does not cover this dental service. Resubmit to the patient's dental insurance plan.
What Does CO-270 Mean?
When paired with Group Code CO, the medical plan is informing you this service is not covered under its benefits and should be submitted to the dental plan. This is a routing notification, not a coverage determination you can appeal. Redirect the claim to the dental plan.
CARC 270 is a routing notification from the medical plan telling you the claim was received but the services are dental in nature and not covered under the medical plan. The payer is directing you to submit the claim to the patient's dental insurance plan for consideration.
This is not a coverage denial in the traditional sense — it is a plan routing issue. The medical plan is confirming that these services fall outside its benefit structure and should be evaluated by the dental plan. Common scenarios include dental procedures billed to a medical plan, oral surgery that straddles the medical-dental boundary, and claims submitted with incorrect insurance information.
The appropriate action is to obtain the patient's dental insurance information and resubmit the claim to the dental plan. Do not appeal the medical plan's determination — instead, redirect the claim.
Common Causes
| Cause | Frequency |
|---|---|
| Dental service submitted to medical plan instead of dental plan The claim was filed with the medical insurance plan but the services are dental in nature and should be submitted to the patient's dental plan | Most Common |
| Service excluded from medical plan coverage The specific service is classified as dental and excluded from the medical plan's covered benefits | Common |
| Coordination of benefits requires dental plan review The medical plan determined the service should be evaluated by the dental plan under coordination of benefits rules | Common |
| Incorrect patient insurance information The patient's insurance details were not properly recorded causing the claim to be routed to the medical plan instead of the dental plan | Occasional |
How to Resolve
- Obtain dental insurance details Get the patient's dental plan information including payer, group number, and member ID.
- Confirm dental plan coverage Contact the dental plan to verify the services are eligible for coverage.
- Submit to the dental plan Resubmit the claim to the dental insurance with complete documentation.
- Track the dental claim Monitor the claim with the dental plan and follow up if not processed within the expected timeframe.
CARC 270 is a plan routing notification. The medical plan is directing the provider to submit the claim to the patient's dental plan. Resubmit to the dental plan rather than appealing the medical plan's determination.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-270:
| RARC | Description |
|---|---|
| N590 | Alert: This service may be covered under the patient's dental plan. Submit the claim to the patient's dental insurance plan for consideration → |
How to Prevent CO-270
- Verify whether services are dental or medical before submitting claims to the appropriate plan
- Coordinate directly with dental plans for dental-related services
- Maintain accurate and current patient insurance information for both medical and dental plans
- Stay current with plan policy changes that may affect dental-medical service boundaries
- Train staff on proper claim routing between medical and dental plans
Also Filed As
The same CARC 270 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/270
- https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.