OA-291: Medical Plan Claim Forwarded to Dental Plan
OA-291 is a routing notification. The medical plan forwarded the claim to the dental plan. Follow up with the dental plan to ensure it was received and is being processed.
What Does OA-291 Mean?
When CARC 291 appears with OA, the medical plan is routing the claim to the dental plan without assigning financial responsibility. This is an informational adjustment indicating the claim is in transit. Final financial responsibility will be determined by the dental plan's adjudication.
CARC 291 is the reverse of CARC 290. It indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and has forwarded the claim to the patient's dental plan for consideration. The medical plan is signaling that the service may fall under the dental plan's scope of coverage.
This code frequently appears for procedures such as oral surgery, dental implants related to medical conditions, or TMJ treatments that were billed to the medical plan but the plan determined fall within the dental benefit category. Many managed care plans draw specific lines between medical and dental coverage, and these boundary services can trigger routing between plans.
The key distinction from CARC 270 is that CARC 291 confirms the claim was forwarded to the dental plan, whereas CARC 270 indicates the medical plan denied the claim without forwarding it. Providers should actively follow up with the dental plan to confirm receipt, as automated forwarding between plans does not always succeed.
Common Causes
| Cause | Frequency |
|---|---|
| Service classified as dental rather than medical The medical plan determined the service falls under dental coverage based on the procedure codes used and plan benefit design | Most Common |
| Coordination of benefits routing Medical plan forwards the claim to the dental plan for primary benefit determination under the plan's COB rules | Common |
| Incorrect plan selection for submission Provider submitted to the medical plan when the service should have been billed to the dental plan initially | Common |
| Plan exclusions for dental-related procedures Medical plan specifically excludes dental-related procedures like oral surgery that may be covered under the dental plan | Common |
| Missing pre-authorization from medical plan Required pre-authorization was not obtained, triggering the medical plan to reroute rather than adjudicate | Occasional |
How to Resolve
Confirm the dental plan received the forwarded claim and ensure it is processed with appropriate documentation.
- Confirm receipt by dental plan Contact the dental plan within 7 days to verify the forwarded claim was received and is in queue for processing.
- Resubmit if not received If the dental plan has no record, submit the claim directly with the patient's dental plan information and any required CDT codes.
How to Prevent OA-291
- Identify whether services belong under dental or medical coverage during pre-service verification
- Use electronic eligibility tools to determine the correct plan for borderline services
General Prevention
- Determine whether the service should be billed to the medical or dental plan before initial submission
- Verify patient eligibility under both plans before rendering services
- Use electronic eligibility verification to confirm correct plan for the procedure
- Stay informed about plan-specific rules regarding dental vs. medical coverage boundaries
- Communicate coverage limitations to patients upfront
Also Filed As
The same CARC 291 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/291
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.