CO-298: Medical Plan Benefits Not Available - Forwarded to Vision
CO-298 means the medical plan contractually denies the vision service and forwarded it. Wait for the vision plan determination before posting any adjustments.
What Does CO-298 Mean?
When CARC 298 appears with CO, the medical plan is contractually denying the vision service and forwarding it. The provider cannot post as a contractual adjustment for the medical plan's denied amount while waiting for the vision plan to process the claim.
CARC 298 is a claim routing code indicating the medical plan received the claim, determined the service falls under vision benefits, and has automatically forwarded the claim to the patient's vision plan for processing. Unlike CARC 297 where the provider must resubmit manually, CARC 298 means the medical plan has taken the forwarding action.
This code appears for the same types of services as CARC 297 — routine eye exams, refractions, eyewear fittings, and other vision-specific services that the medical plan excludes from coverage. The difference is purely in the forwarding mechanism: with CARC 298, the payer has handled the routing. However, providers should not assume the forwarding was successful. Electronic claim routing between plans does not always work smoothly, and claims can get lost in the handoff.
The provider's primary responsibility after receiving CARC 298 is to follow up with the vision plan to confirm receipt of the forwarded claim. If the vision plan has no record of the claim after 7-10 business days, the provider should submit the claim directly to the vision plan rather than waiting for the medical plan's forwarding to complete.
Common Causes
| Cause | Frequency |
|---|---|
| Vision service classified under vision benefit, not medical The medical plan determined the service is a vision benefit and forwarded the claim to the patient's vision plan for processing | Most Common |
| Service excluded from medical plan coverage The specific vision service is excluded from the medical plan's covered benefits | Common |
| Coordination of benefits requires vision plan processing The medical plan's COB rules direct the claim to the vision plan | Common |
| Incorrect plan routing The claim was submitted to the medical plan when it should have been sent to the vision plan | Occasional |
How to Resolve
- Track vision plan processing Monitor the vision plan's adjudication of the forwarded claim. Do not write off the balance until the vision plan has completed processing.
- Post adjustments after determination Once the vision plan processes the claim, post the appropriate payment or adjustment. If the vision plan also denies, investigate the denial reason.
CARC 298 indicates the medical plan has forwarded the claim to the patient's vision plan. Follow up with the vision plan rather than appealing the medical plan.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-298:
| RARC | Description |
|---|---|
| N590 | Alert: This claim has been forwarded to the patient's vision plan for consideration. Follow up with the vision plan to ensure the forwarded claim is being processed → |
How to Prevent CO-298
- Bill the correct plan initially by verifying benefit design for vision services during patient intake
- Collect vision insurance information alongside medical insurance during registration
General Prevention
- Perform eligibility verification for both medical and vision plans before claim submission
- Coordinate benefits effectively for multi-plan scenarios involving vision services
- Use accurate current coding per plan guidelines for vision services
- Maintain comprehensive service documentation
- Monitor plan policy updates and communicate changes internally
Also Filed As
The same CARC 298 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/298
- 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.