OA-291: Medical Plan Benefits Not Available - Forwarded to Dental

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. 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.

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.

How to Resolve

1. 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.
2. 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

Also Filed As

The same CARC 291 may appear with different Group Codes:

Related Denial Codes