PR-270: Medical Plan Benefits Not Available - Submit to Dental

What Does PR-270 Mean?

CARC 270 is a routing notification from the medical plan telling you the claim was received but the services are dental in nature and not covered under the medical plan. The payer is directing you to submit the claim to the patient's dental insurance plan for consideration.

This is not a coverage denial in the traditional sense — it is a plan routing issue. The medical plan is confirming that these services fall outside its benefit structure and should be evaluated by the dental plan. Common scenarios include dental procedures billed to a medical plan, oral surgery that straddles the medical-dental boundary, and claims submitted with incorrect insurance information.

The appropriate action is to obtain the patient's dental insurance information and resubmit the claim to the dental plan. Do not appeal the medical plan's determination — instead, redirect the claim.

How to Resolve

Verify the patient's dental insurance, resubmit the claim to the dental plan, and update insurance records.

1. Verify patient dental plan information Obtain the patient's dental insurance details including the payer name, group number, member ID, and claims submission address.
2. Confirm service eligibility under dental plan Check which services on the claim are eligible for dental plan coverage before resubmitting.
3. Contact the dental plan directly Reach out to the dental plan to confirm coverage and any specific billing requirements for the services.
4. Submit the claim to the dental plan Resubmit the claim to the patient's dental insurance with complete documentation.
5. Monitor claim progress Track the dental plan claim and follow up to ensure it is processed.
6. Communicate with the patient If neither plan covers the service, inform the patient of their financial responsibility.

Also Filed As

The same CARC 270 may appear with different Group Codes:

Related Denial Codes