OA-297: Medical Plan Benefits Not Available - Submit to Vision

What Does OA-297 Mean?

When CARC 297 appears with OA, the medical plan is directing the provider to submit to the vision plan without assigning financial responsibility. The provider should submit to the vision plan, and if no vision coverage exists, the patient may be responsible for the balance. 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 297 indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and is directing the provider to submit the claim to the patient's vision plan instead. Unlike CARC 298 (which indicates the medical plan forwarded the claim automatically), CARC 297 places the resubmission responsibility on the provider.

This code appears for vision-related services such as routine eye exams, refractions, contact lens fittings, and eyewear that were billed to the medical plan. Many patients have separate vision insurance through carriers like VSP, EyeMed, or Davis Vision, and the medical plan does not cover services that fall within the vision benefit scope. The medical plan is telling you that the service is not their responsibility and directing you to the correct payer.

The critical action item with CARC 297 is that you must actively resubmit the claim to the vision plan. The medical plan has not forwarded it on your behalf. If you do not resubmit, the claim will remain unpaid. You need the patient's vision plan information including the payer ID, group number, and member ID to submit correctly. Some services, such as medical eye conditions like glaucoma or diabetic retinal exams, may be covered under the medical plan if billed with the appropriate medical diagnosis codes.

How to Resolve

1. Submit to vision plan or bill patient If the patient has a vision plan, submit there. If not, the patient may be responsible for the service cost.

How to Prevent OA-297

• Identify whether patients have separate vision coverage during intake to avoid routing delays

Also Filed As

The same CARC 297 may appear with different Group Codes:

Related Denial Codes