CARC 305 Active

OA-305: Medical Plan Claim — Forwarded to Hearing Plan

TL;DR

Claim forwarded during COB. Monitor the hearing plan for payment.

Action
Review & Decide
Who Pays
Depends
Appeal
Yes
Patient Impact
Indirect
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does OA-305 Mean?

During COB processing, the medical plan forwarded the claim to the hearing plan. The OA adjustment reflects the claim has been routed to the correct payer.

CARC 305 is an informational code indicating the medical plan has already taken action on the provider's behalf. Unlike CARC 304 (which tells you to submit to the hearing plan), CARC 305 confirms the medical plan has already forwarded the claim to the hearing plan. The medical plan recognized the service as hearing-related, denied its own coverage, and automatically routed the claim.

This auto-forwarding typically occurs when the medical plan and hearing plan have an integrated relationship with automatic claim routing configured. While no resubmission is necessary, the provider should monitor the hearing plan for adjudication and follow up if payment is not received within a reasonable timeframe.

Common Causes

Cause Frequency
COB auto-forwarding to hearing plan During coordination of benefits, the medical plan forwarded the claim to the hearing plan Most Common
Multiple plan coordination Claim processing identified the hearing plan as the appropriate payer and forwarded accordingly Common

How to Resolve

  1. Monitor the hearing plan for adjudication of the forwarded claim
  2. Verify COB processing is complete
  3. Follow up with the hearing plan if no payment is received
Appeal Guide

Appeal with clinical documentation showing the service is medical and should be covered under the medical plan rather than the hearing plan.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-305:

RARC Description
N527 Payment has been issued to another plan/entity for this claim. Monitor the hearing plan for payment on the forwarded claim →

How to Prevent OA-305

Also Filed As

The same CARC 305 may appear with different Group Codes:

CO-305 PR-305

Related Denial Codes

OA-301 — Medical Plan Claim — Submit to Behavioral Health Plan OA-304 — Medical Plan Claim — Submit to Hearing Plan OA-B11 — Claim Transferred to Proper Payer — Not Covered Here OA-19 — Workers' Compensation Claim OA-20 — Liability Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.cms.gov/medicare/payment/prospective-payment-systems
  3. Codes maintained by X12. Visit x12.org for official definitions.