CO-305: Claim Forwarded to Hearing Plan
The medical plan forwarded the claim to the hearing plan. Wait for the hearing plan's adjudication before taking further action.
What Does CO-305 Mean?
CO-305 indicates the medical plan is contractually adjusting the claim because hearing benefits do not exist under the medical plan. The CO designation reflects that this is a plan structure issue, not a billing error. The claim has been forwarded to the hearing plan, so the provider should not write off the charges — instead, wait for the hearing plan to adjudicate. The CO adjustment simply closes the medical plan's involvement in this claim.
When CARC 305 appears on a remittance, the medical plan is telling you two things at once: hearing benefits are not available under the medical plan, and the medical plan has already taken the step of forwarding your claim to the patient's hearing plan. This is an informational code, not a traditional denial requiring provider action to redirect the claim.
The practical difference between CARC 305 and CARC 304 matters for your workflow. With CARC 304, you must identify the hearing plan and resubmit the claim yourself. With CARC 305, the medical plan's system automatically identified the hearing plan and forwarded the claim. Your responsibility shifts from claim submission to claim monitoring — you need to follow up with the hearing plan to confirm receipt and track adjudication.
The risk with CARC 305 is assuming the forwarded claim will process smoothly without follow-up. Automated forwarding can fail for various reasons: the hearing plan may not have the patient's current eligibility on file, the claim format may not meet the hearing plan's requirements, or the forwarded claim may get lost in the transfer. Proactive follow-up with the hearing plan is essential to ensure payment.
Common Causes
| Cause | Frequency |
|---|---|
| Hearing services billed to medical plan The claim for hearing-related services was submitted to the patient's general medical insurance, which does not cover hearing benefits. Unlike CARC 304 where the provider must redirect the claim, here the medical plan automatically forwards it to the hearing plan | Most Common |
| Incorrect insurance information on file The patient's hearing plan details were not collected or were entered incorrectly during registration, causing the claim to initially go to the medical plan before being forwarded | Common |
| Coordination of benefits auto-routing The medical plan's claims processing system identified the services as hearing-related and automatically forwarded them to the patient's hearing plan as part of standard COB procedures | Common |
| Plan exclusions for hearing services The patient's medical plan explicitly excludes hearing services from its coverage, triggering automatic forwarding to the separate hearing benefit plan | Common |
| Eligibility or coverage gap on hearing plan The claim was forwarded to the hearing plan but may still be denied if the patient's hearing coverage has expired, is inactive, or does not cover the specific services rendered | Occasional |
How to Resolve
Confirm the hearing plan received the forwarded claim, then monitor it through adjudication.
- Confirm claim forwarding Verify with the hearing plan that the forwarded claim was received. If not, submit the claim directly to the hearing plan with the medical plan's remittance attached as supporting documentation.
- Monitor hearing plan processing Track the forwarded claim through the hearing plan's adjudication process. Set a follow-up reminder based on the hearing plan's standard processing timeframe.
- Post payment or pursue further action When the hearing plan remittance arrives, post the payment. If the hearing plan denies, follow the hearing plan's appeal process or determine patient responsibility based on the hearing plan's adjudication.
This is a standard contractual adjustment. The amount is a provider write-off per your payer contract.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-305:
| RARC | Description |
|---|---|
| N130 | Alert: You may need to review plan documents or guidelines for coverage details related to this service. |
| N381 | Alert: Consult your contractual agreement for billing and payment information. |
How to Prevent CO-305
- Collect hearing plan information at registration and bill hearing services directly to the hearing plan to avoid delays from automatic forwarding
- Maintain a list of which medical plan insurers automatically forward hearing claims versus which require manual redirect
- Track automatically forwarded claims separately to ensure they do not fall through the cracks during the hearing plan's processing
General Prevention
- Collect complete insurance information including hearing plan details during patient registration to enable direct billing to the correct plan
- Verify hearing plan eligibility and benefits before rendering hearing-related services
- Bill hearing-related services directly to the hearing plan from the start to avoid unnecessary forwarding and processing delays
- Maintain updated records of which insurers have separate hearing plans and which services are carved out from the medical plan
- Track forwarded claims to ensure the hearing plan processes them within expected timeframes
Also Filed As
The same CARC 305 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/305
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.