CO-290: Dental Plan Claim Forwarded to Medical Plan
CO-290 means the dental plan contractually denies coverage and has forwarded the claim. Do not bill the patient for the dental denial amount while the medical plan processes the claim.
What Does CO-290 Mean?
When CARC 290 appears with CO, the dental plan is denying the claim as a contractual obligation while forwarding it. This indicates the dental plan considers the service outside their contractual coverage scope. The provider cannot bill the patient for the dental plan's portion of the denial while waiting for the medical plan's determination.
CARC 290 is a claim routing code rather than a true denial. When this code appears, it means the dental plan received your claim, determined that the service is not covered under the dental benefit, and has forwarded the claim to the patient's medical plan for further consideration. The dental plan is essentially saying the service may qualify for coverage under medical benefits instead.
This code commonly appears for procedures that sit on the boundary between dental and medical coverage. Oral surgery procedures, certain maxillofacial treatments, and medically necessary dental work related to trauma or systemic conditions are frequent triggers. The dental plan recognizes that these services may be within the scope of medical coverage even though they involve the oral cavity.
The important distinction between CARC 290 and CARC 254 is that 290 indicates the claim was actually forwarded to the medical plan, while 254 means the dental plan denied the claim without forwarding it. With CARC 290, the claim should already be in the medical plan's queue, but providers should not assume the forwarding was successful. Active follow-up with the medical plan is essential to avoid the claim falling through the cracks.
Common Causes
| Cause | Frequency |
|---|---|
| Service not covered under dental plan The specific procedure is excluded from the dental plan's benefits but may qualify for coverage under the medical plan | Most Common |
| Coordination of benefits routing Dental plan requires the claim to be forwarded to the medical plan for primary benefit determination | Common |
| Claim submitted to wrong plan Service should have been billed to the medical plan initially rather than the dental plan | Common |
| Missing pre-authorization Dental plan required prior authorization that was not obtained, triggering a forwarding to the medical plan | Occasional |
How to Resolve
Confirm the claim was successfully forwarded to the medical plan and follow up to ensure it is processed.
- Track both plan determinations Monitor the medical plan's adjudication of the forwarded claim. Do not write off the balance until the medical plan has made its determination.
- Post adjustments correctly Once the medical plan processes the claim, post the appropriate adjustments based on their determination. If the medical plan pays, reconcile against the dental denial.
How to Prevent CO-290
- Bill the correct plan initially by verifying benefit design for dental-medical crossover services
- Obtain prior authorization from the appropriate plan before rendering services
General Prevention
- Verify whether services should be billed to the dental or medical plan before initial submission
- Check patient eligibility under both plans before rendering services
- Coordinate with medical plans proactively for services that straddle dental and medical coverage
- Obtain prior authorization from the correct plan before delivering services
Also Filed As
The same CARC 290 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/290
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.