CARC 305 Active

CO-305: Medical Plan Claim — Forwarded to Hearing Plan

TL;DR

Claim auto-forwarded to the hearing plan. Monitor for payment; no resubmission needed.

Action
Review & Decide
Who Pays
Provider
Appeal
Yes
Patient Impact
None
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does CO-305 Mean?

The medical plan has already forwarded the claim to the hearing plan. The CO adjustment reflects that the medical plan is not covering this service. The provider should monitor the hearing plan for payment.

CARC 305 is an informational code indicating the medical plan has already taken action on the provider's behalf. Unlike CARC 304 (which tells you to submit to the hearing plan), CARC 305 confirms the medical plan has already forwarded the claim to the hearing plan. The medical plan recognized the service as hearing-related, denied its own coverage, and automatically routed the claim.

This auto-forwarding typically occurs when the medical plan and hearing plan have an integrated relationship with automatic claim routing configured. While no resubmission is necessary, the provider should monitor the hearing plan for adjudication and follow up if payment is not received within a reasonable timeframe.

Common Causes

Cause Frequency
Automatic hearing plan routing Medical plan automatically identified the service as hearing-related and forwarded the claim to the patient's hearing plan Most Common
Hearing benefit carve-out with auto-forwarding Patient's plan has a hearing carve-out with automatic claim forwarding configured between the medical and hearing plans Most Common
Hearing services submitted to medical plan Provider submitted hearing-related services to the medical plan, which recognized and forwarded them automatically Common

How to Resolve

  1. No immediate action required — the claim has already been forwarded to the hearing plan
  2. Monitor the hearing plan's adjudication of the forwarded claim
  3. Follow up with the hearing plan if no response is received within 30 days
  4. If the service is medical and not hearing-related, contact the medical plan to request processing under the medical benefit
Appeal Guide

Appeal if the service is medical and not hearing-related. Provide clinical documentation showing the service should be covered under the medical plan. Note that the claim has already been forwarded, so simultaneous processing may occur.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-305:

RARC Description
N527 Payment has been issued to another plan/entity for this claim. Claim has been forwarded — monitor the hearing plan for adjudication →
N381 Alert: Consult your contractual agreement for restrictions, billing, and payment information. Review contract to understand hearing plan forwarding arrangements →

How to Prevent CO-305

Also Filed As

The same CARC 305 may appear with different Group Codes:

OA-305 PR-305

Related Denial Codes

CO-301 — Medical Plan Claim — Submit to Behavioral Health Plan CO-304 — Medical Plan Claim — Submit to Hearing Plan CO-B11 — Claim Transferred to Proper Payer — Not Covered Here CO-B4 — Late Filing Penalty CO-23 — Prior Payer Adjudication Impact

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.cms.gov/medicare/payment/prospective-payment-systems
  3. Codes maintained by X12. Visit x12.org for official definitions.