OA-300: Medical Plan Benefits Not Available - Submit to Behavioral Health

What Does OA-300 Mean?

When CARC 300 appears with OA, the medical plan is routing the claim to the behavioral health plan as an informational adjustment. Financial responsibility will be determined by the behavioral health plan's adjudication. This is the typical pairing since the code represents claim routing rather than a final financial determination. 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 300 is a claim routing code indicating the medical plan received the claim, determined the service belongs under behavioral health coverage, and has automatically forwarded it to the patient's behavioral health plan for processing. This code is a forwarding confirmation, not a final denial.

This code is common in managed care arrangements where behavioral health benefits are carved out and managed by a separate entity. Many employers and health plans contract with specialty behavioral health organizations like Optum Behavioral Health, Carelon Behavioral Health, or Magellan to administer mental health and substance abuse benefits separately from medical/surgical benefits. When a provider submits a behavioral health claim to the medical plan, the medical plan recognizes the service type and routes it to the carved-out behavioral health administrator.

The distinction between CARC 300 and CARC 301 is important. CARC 300 means the medical plan has forwarded the claim to the behavioral health plan on your behalf. CARC 301 means the medical plan is telling you to submit the claim to the behavioral health plan yourself. With CARC 300, the claim should already be in the behavioral health plan's queue, but active follow-up is still recommended to ensure the forwarding was successful.

How to Resolve

1. Confirm receipt by behavioral health plan Contact the behavioral health plan within 7-10 days to verify the forwarded claim was received.
2. Resubmit if not received If the behavioral health plan has no record, submit directly with the patient's behavioral health insurance information.

How to Prevent OA-300

• Identify whether the patient's behavioral health benefits are carved out during registration
• Verify the correct payer for behavioral health services before initial claim submission

Also Filed As

The same CARC 300 may appear with different Group Codes:

Related Denial Codes