OA-298: Medical Plan Benefits Not Available - Forwarded to Vision

What Does OA-298 Mean?

When CARC 298 appears with OA, the medical plan is routing the claim to the vision plan as an informational adjustment without assigning financial responsibility. This is the expected pairing since the claim is in transit. The final financial outcome will depend on the vision 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 298 is a claim routing code indicating the medical plan received the claim, determined the service falls under vision benefits, and has automatically forwarded the claim to the patient's vision plan for processing. Unlike CARC 297 where the provider must resubmit manually, CARC 298 means the medical plan has taken the forwarding action.

This code appears for the same types of services as CARC 297 — routine eye exams, refractions, eyewear fittings, and other vision-specific services that the medical plan excludes from coverage. The difference is purely in the forwarding mechanism: with CARC 298, the payer has handled the routing. However, providers should not assume the forwarding was successful. Electronic claim routing between plans does not always work smoothly, and claims can get lost in the handoff.

The provider's primary responsibility after receiving CARC 298 is to follow up with the vision plan to confirm receipt of the forwarded claim. If the vision plan has no record of the claim after 7-10 business days, the provider should submit the claim directly to the vision plan rather than waiting for the medical plan's forwarding to complete.

How to Resolve

1. Confirm receipt Contact the vision plan within 7-10 days to verify the forwarded claim was received and is in processing queue.
2. Resubmit if not received If the vision plan has no record, submit directly with the patient's vision insurance information.

How to Prevent OA-298

• Identify whether patients have separate vision coverage during registration to bill the correct plan initially
• Use eligibility verification tools to check vision plan coverage before claim submission

Also Filed As

The same CARC 298 may appear with different Group Codes:

Related Denial Codes