CO-290: Dental Plan Benefits Not Available - Forwarded to Medical
CO-290 means the dental plan contractually denies coverage and has forwarded the claim. Do not post as a contractual adjustment 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 post as a contractual adjustment 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 classified as medical rather than dental The dental plan determined the service is medical in nature and should be covered by the medical plan rather than the dental plan | Most Common |
| Service excluded from dental plan coverage The specific treatment is not included in the dental plan's covered benefits | Common |
| Coordination of benefits requires medical plan review The dental plan's COB rules require the medical plan to review the claim before the dental plan will adjudicate | Common |
| Incorrect plan routing The claim was submitted to the dental plan when it should have been sent to the medical plan based on the service type | Occasional |
How to Resolve
- 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.
CARC 290 indicates the dental plan has forwarded the claim to the patient's medical plan. This is a routing notification, not a coverage denial. Follow up with the medical plan to ensure the claim is being processed rather than filing an appeal with the dental plan.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-290:
| RARC | Description |
|---|---|
| N590 | Alert: This claim has been forwarded to the patient's medical plan for consideration. Follow up with the medical plan to ensure the forwarded claim is being processed → |
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 submission
- Maintain accurate and current patient insurance information for both plans
- Stay current with plan updates regarding dental vs medical coverage boundaries
- Train staff on proper claim routing between dental and medical plans
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://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.