PR-290: Dental Plan Benefits Not Available - Forwarded to Medical

What Does PR-290 Mean?

When paired with Group Code PR, CARC 290 shifts the financial responsibility to the patient. The adjustment for dental plan benefits not available - forwarded to medical is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

CARC 290 is a claim routing code rather than a true denial. When this code appears, it means the dental plan received your claim, determined that the service is not covered under the dental benefit, and has forwarded the claim to the patient's medical plan for further consideration. The dental plan is essentially saying the service may qualify for coverage under medical benefits instead.

This code commonly appears for procedures that sit on the boundary between dental and medical coverage. Oral surgery procedures, certain maxillofacial treatments, and medically necessary dental work related to trauma or systemic conditions are frequent triggers. The dental plan recognizes that these services may be within the scope of medical coverage even though they involve the oral cavity.

The important distinction between CARC 290 and CARC 254 is that 290 indicates the claim was actually forwarded to the medical plan, while 254 means the dental plan denied the claim without forwarding it. With CARC 290, the claim should already be in the medical plan's queue, but providers should not assume the forwarding was successful. Active follow-up with the medical plan is essential to avoid the claim falling through the cracks.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 290 adjustment. Review the remittance advice and any RARC codes for context.
2. Review for potential errors Check whether the underlying denial reason can be corrected, which may eliminate the patient's responsibility. Verify coding accuracy and documentation completeness.
3. Appeal if designation is incorrect If the PR assignment appears incorrect or the denial is in error, file an appeal with supporting documentation before billing the patient.
4. Generate patient statement If the determination is correct, generate a patient statement for the amount and follow standard patient collection procedures.
5. Communicate with the patient Explain the charge to the patient, provide information about their financial responsibility, and discuss payment options.

How to Prevent PR-290

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-290 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 290 may appear with different Group Codes:

Related Denial Codes