CO-291: Medical Plan Claim Forwarded to Dental Plan
CO-291 means the medical plan contractually denies the service and forwarded it to dental. Do not balance bill the patient until the dental plan makes its determination.
What Does CO-291 Mean?
When CARC 291 appears with CO, the medical plan is contractually denying coverage and forwarding the claim. The provider cannot bill the patient for the medical plan denial while the dental plan adjudicates the forwarded claim.
CARC 291 is the reverse of CARC 290. It indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and has forwarded the claim to the patient's dental plan for consideration. The medical plan is signaling that the service may fall under the dental plan's scope of coverage.
This code frequently appears for procedures such as oral surgery, dental implants related to medical conditions, or TMJ treatments that were billed to the medical plan but the plan determined fall within the dental benefit category. Many managed care plans draw specific lines between medical and dental coverage, and these boundary services can trigger routing between plans.
The key distinction from CARC 270 is that CARC 291 confirms the claim was forwarded to the dental plan, whereas CARC 270 indicates the medical plan denied the claim without forwarding it. Providers should actively follow up with the dental plan to confirm receipt, as automated forwarding between plans does not always succeed.
Common Causes
| Cause | Frequency |
|---|---|
| Service classified as dental rather than medical The medical plan determined the service falls under dental coverage based on the procedure codes used and plan benefit design | Most Common |
| Coordination of benefits routing Medical plan forwards the claim to the dental plan for primary benefit determination under the plan's COB rules | Common |
| Incorrect plan selection for submission Provider submitted to the medical plan when the service should have been billed to the dental plan initially | Common |
| Plan exclusions for dental-related procedures Medical plan specifically excludes dental-related procedures like oral surgery that may be covered under the dental plan | Common |
| Missing pre-authorization from medical plan Required pre-authorization was not obtained, triggering the medical plan to reroute rather than adjudicate | Occasional |
How to Resolve
Confirm the dental plan received the forwarded claim and ensure it is processed with appropriate documentation.
- Monitor dental plan processing Wait for the dental plan to adjudicate the forwarded claim before taking any write-off or billing action.
- Post adjustments after dental determination Once the dental plan processes the claim, post the appropriate payment or adjustment based on their determination.
How to Prevent CO-291
- Verify which plan covers the procedure before initial claim submission
- Obtain preauthorization from the correct plan for services that cross dental-medical boundaries
General Prevention
- Determine whether the service should be billed to the medical or dental plan before initial submission
- Verify patient eligibility under both plans before rendering services
- Use electronic eligibility verification to confirm correct plan for the procedure
- Stay informed about plan-specific rules regarding dental vs. medical coverage boundaries
- Communicate coverage limitations to patients upfront
Also Filed As
The same CARC 291 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/291
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.