CO-297: Medical Plan Benefits Not Available - Submit to Vision

What Does CO-297 Mean?

When CARC 297 appears with CO, the medical plan is contractually denying the vision service. The provider cannot post as a contractual adjustment for this adjustment. The provider must submit the claim to the vision plan to receive payment. If the patient has no vision plan, the provider may need to write off the balance depending on their contract terms.

CARC 297 indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and is directing the provider to submit the claim to the patient's vision plan instead. Unlike CARC 298 (which indicates the medical plan forwarded the claim automatically), CARC 297 places the resubmission responsibility on the provider.

This code appears for vision-related services such as routine eye exams, refractions, contact lens fittings, and eyewear that were billed to the medical plan. Many patients have separate vision insurance through carriers like VSP, EyeMed, or Davis Vision, and the medical plan does not cover services that fall within the vision benefit scope. The medical plan is telling you that the service is not their responsibility and directing you to the correct payer.

The critical action item with CARC 297 is that you must actively resubmit the claim to the vision plan. The medical plan has not forwarded it on your behalf. If you do not resubmit, the claim will remain unpaid. You need the patient's vision plan information including the payer ID, group number, and member ID to submit correctly. Some services, such as medical eye conditions like glaucoma or diabetic retinal exams, may be covered under the medical plan if billed with the appropriate medical diagnosis codes.

Common Causes

How to Resolve

1. Submit to vision plan Get the patient's vision plan details and submit the claim directly. This is the primary path to payment.
2. Appeal if medically necessary If the service is medically necessary (not routine vision), appeal the medical plan denial with supporting diagnosis codes and clinical documentation.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-297:

How to Prevent CO-297

• Verify whether vision services should be billed to the medical or vision plan during patient check-in
• Collect vision insurance information during patient registration alongside medical insurance
• Use medical diagnosis codes for eye conditions that qualify for medical plan coverage

General Prevention

• Verify whether services should be billed to the medical or vision plan before claim submission
• Maintain current patient insurance information for both medical and vision plans
• Train staff on proper claim routing between medical and vision plans
• Stay current with plan changes affecting medical vs vision benefit boundaries
• Implement pre-submission checks to verify correct plan routing for vision-related services

Also Filed As

The same CARC 297 may appear with different Group Codes:

Related Denial Codes