CARC 289 Active

OA-289: Dental and Medical Plans Considered - Benefits Not Available

TL;DR

OA-289 means the claim is denied under both plans with unclear liability. Investigate whether the patient is responsible or if the balance should be written off.

Action
Review & Decide
Who Pays
Depends
Appeal
No
Patient Impact
Indirect
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 OA-289 Mean?

When CARC 289 appears with OA, the financial responsibility is not clearly assigned. This may indicate the payer is flagging the denial without assigning it to either the provider or the patient. The provider should investigate whether the patient can be billed for the service or whether the amount should be written off. In the OA context, this adjustment typically relates to coordination of benefits between a primary and secondary payer, where the financial responsibility is determined through the COB process.

When CARC 289 appears on your remittance, the payer is communicating that the services billed have been evaluated under both the dental and medical plan benefit structures, and coverage is not available under either one. This code sits at the intersection of dental-medical coordination and is often triggered when a procedure could theoretically fall under either benefit type but the patient's specific plan design excludes it from both.

This denial frequently surfaces with procedures that straddle the dental-medical boundary, such as certain oral surgery procedures, TMJ treatments, or dental anesthesia services. The payer has determined that the dental plan does not cover the service, and the medical plan also does not provide benefits for it. Unlike CARC 290 or 291 where the claim is forwarded to the other plan, CARC 289 indicates that both avenues have been exhausted.

The financial impact depends heavily on the group code. With CO, the provider absorbs the cost. With OA, the responsibility may fall on the patient or require further investigation. Before writing off the balance, verify that the correct procedure and diagnosis codes were used, as coding adjustments may allow the claim to be reprocessed successfully under one of the plans. Related codes to be aware of include CARC 254, 270, and 280, which address similar cross-plan coverage scenarios.

How to Resolve

  1. Clarify liability Contact the payer to determine whether the balance can be billed to the patient or must be written off by the provider.
  2. Bill the patient if appropriate If the payer confirms the patient is responsible, issue a patient statement with an explanation of why the insurance did not cover the service.
Do Not Appeal This Code

Dental and Medical Plans Considered - Benefits Not Available grouped under OA is an Other Adjustment that doesn't fall into the standard contractual write-off or patient responsibility categories. Whether action is needed depends on the specific reason — review any accompanying RARC codes and payer guidance to decide whether this is a final adjustment to accept or an issue to resolve through resubmission.

How to Prevent OA-289

Also Filed As

The same CARC 289 may appear with different Group Codes:

CO-289 PR-289

Related Denial Codes

OA-74 — Indirect Medical Education Adjustment OA-75 — Direct Medical Education Adjustment OA-76 — Disproportionate Share Adjustment OA-85 — Patient Interest Adjustment OA-89 — Professional Fees Removed from Charges

Sources

  1. https://www.mdclarity.com/denial-code/289
  2. https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.