CO-301: Medical Plan Claim — Submit to Behavioral Health Plan
Resubmit to the behavioral health plan. Do not collect from the patient for this adjustment.
What Does CO-301 Mean?
The medical plan treats this as a contractual obligation adjustment. The provider cannot collect the denied amount from the patient and must either resubmit to the behavioral health plan or absorb the cost if no other plan applies.
CARC 301 appears on a remittance when the medical plan determines that the billed service falls under behavioral health coverage rather than the medical benefit. Many insurers use a carve-out arrangement that separates behavioral health from the medical plan, and when the medical plan identifies a claim as behavioral health, it denies the claim and directs the provider to submit it to the appropriate behavioral health plan.
This code is most common when providers submit mental health or substance abuse services to a medical plan that does not administer those benefits. It can also appear when diagnosis or procedure codes on the claim trigger the medical plan's behavioral health classification logic, even if the provider views the service as primarily medical.
Common Causes
| Cause | Frequency |
|---|---|
| Service classified as behavioral health Medical plan determined the service falls under behavioral health coverage and the provider must submit to the behavioral health plan | Most Common |
| Behavioral health carve-out Patient's plan uses a behavioral health carve-out arrangement where the medical plan does not process behavioral health claims | Most Common |
| Incorrect plan submission Provider submitted behavioral health services to the medical plan instead of the appropriate behavioral health plan | Common |
| Missing pre-authorization from behavioral health plan Required preauthorization was not obtained from the behavioral health plan before services were rendered | Common |
| Billing errors or incorrect coding Incorrect diagnosis or procedure codes led the medical plan to classify the service as behavioral health | Common |
How to Resolve
- Identify the patient's behavioral health plan by checking the insurance card or contacting the medical plan's provider services line
- Obtain the correct payer ID and electronic submission details for the behavioral health plan
- Resubmit the claim to the behavioral health plan with all required documentation
- Verify whether pre-authorization is required by the behavioral health plan before resubmission
- If you believe the service is medical rather than behavioral health, file an appeal with the medical plan and include physician notes, prior authorization records, and relevant coverage policies
Appeal with documentation of medical necessity and clinical justification showing the service is medical, not behavioral health. Include physician notes, prior authorization records, and relevant coverage policies. Reference the specific plan language that covers the service under the medical plan.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-301:
| RARC | Description |
|---|---|
| N527 | Payment has been issued to another plan/entity for this claim. Contact the medical plan to obtain details of the behavioral health plan and resubmit → |
| N381 | Alert: Consult your contractual agreement for restrictions, billing, and payment information. Review the payer contract to determine the correct behavioral health plan for resubmission → |
How to Prevent CO-301
- Verify whether the patient has a separate behavioral health plan during registration
- Conduct thorough eligibility checks to determine the correct plan for behavioral health services
- Establish communication with behavioral health plans before rendering services
- Train staff on coverage distinctions between medical and behavioral health plans
- Use electronic claim submission systems that route claims to the correct plan
Also Filed As
The same CARC 301 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/301
- https://www.cms.gov/medicare/payment/prospective-payment-systems
- Codes maintained by X12. Visit x12.org for official definitions.