CO-298: Medical Plan Claim Forwarded to Vision Plan
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 bill the patient 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 |
|---|---|
| Service classified as vision benefit Medical plan determined the service is a vision benefit and automatically forwarded the claim to the vision plan | Most Common |
| Inaccurate insurance information Incorrect or outdated patient insurance data on file caused the claim to go to the wrong plan initially | Common |
| Coordination of benefits routing Patient has multiple plans and the medical plan forwards vision-related claims to the appropriate vision insurer | Common |
| Plan limitations or exclusions Medical plan specifically excludes the vision service, triggering automatic forwarding to the vision plan | Common |
| Missing pre-authorization Required approvals or referrals were not obtained from the correct plan | Occasional |
How to Resolve
Confirm the vision plan received the forwarded claim and follow up on processing.
- 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.
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
- Verify eligibility and determine the correct plan before claim submission
- Identify whether the patient has a separate vision plan during registration and intake
- Coordinate benefits properly between medical and vision insurers
- Apply accurate coding per plan guidelines to route claims correctly
- Monitor plan policy changes regarding vision benefit classifications
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://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.