OA-270: Submit to Dental Plan Instead

What Does OA-270 Mean?

OA-270 indicates the medical-to-dental redirection involves coordination of benefits. The medical plan processed the claim but determined it belongs under the dental benefit, and the OA group code signals that the amount should be forwarded to the dental plan rather than written off or billed to the patient.

When CARC 270 appears on a remittance, the medical insurance plan is telling you it processed the claim but determined the billed services fall under the patient's dental benefits rather than medical coverage. The payer is directing you to resubmit the claim to the patient's dental plan for further consideration. The medical plan is not disputing that the service was performed — it is saying the service belongs in the dental benefit category.

This denial is common in practices that bridge the medical-dental boundary: oral surgeons, periodontists, ENT physicians, and providers who treat conditions like TMJ disorders, sleep apnea appliances, or trauma-related oral surgery. The line between what constitutes a medical versus dental service varies significantly by payer. Some payers classify all oral procedures as dental regardless of the clinical context, while others cover medically necessitated oral procedures (such as extraction due to radiation therapy or jaw surgery following an accident) under medical benefits.

The financial impact depends on whether the patient has dental insurance. If they do, redirecting the claim to the dental plan is straightforward. If they do not, the provider must determine whether the service qualifies for a medical necessity appeal — arguing that the procedure should be covered under medical benefits due to the clinical circumstances — or whether the patient must pay out of pocket. Under CO, the medical plan write-off means the provider absorbs the cost unless the claim can be successfully rerouted to another payer.

Common Causes

How to Resolve

Determine whether the service is a dental or medical benefit, redirect the claim to the patient's dental plan if appropriate, or appeal the medical plan denial if the service is medically necessitated.

1. Identify the dental plan Locate the patient's dental insurance information and verify coverage for the billed service.
2. Submit to the dental plan with the medical remittance File the claim with the dental plan, attaching the medical plan's remittance showing the OA-270 adjustment.
3. Post the final balance after dental adjudication After the dental plan adjudicates, post any remaining balance per the applicable contract terms.

How to Prevent OA-270

• Collect both medical and dental insurance information during registration to ensure proper routing from the start
• Submit dental services directly to the dental plan rather than routing through the medical plan first
• Track medical-dental COB patterns to identify services that are frequently misrouted

General Prevention

• Collect both medical and dental insurance information during patient registration and verify coverage for the planned service
• Determine whether the service is classified as medical or dental under the patient's plans before submitting the claim
• Maintain clear documentation distinguishing medical necessity for procedures that could be classified under either medical or dental coverage
• Submit claims to the correct plan (medical vs. dental) based on the service type and payer classification
• Stay current with payer policies on which services are considered dental vs. medical benefits

Also Filed As

The same CARC 270 may appear with different Group Codes:

Related Denial Codes