PR-291: Medical Plan Benefits Not Available - Forwarded to Dental

What Does PR-291 Mean?

When paired with Group Code PR, CARC 291 shifts the financial responsibility to the patient. The adjustment for medical plan benefits not available - forwarded to dental is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

CARC 291 is the reverse of CARC 290. It indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and has forwarded the claim to the patient's dental plan for consideration. The medical plan is signaling that the service may fall under the dental plan's scope of coverage.

This code frequently appears for procedures such as oral surgery, dental implants related to medical conditions, or TMJ treatments that were billed to the medical plan but the plan determined fall within the dental benefit category. Many managed care plans draw specific lines between medical and dental coverage, and these boundary services can trigger routing between plans.

The key distinction from CARC 270 is that CARC 291 confirms the claim was forwarded to the dental plan, whereas CARC 270 indicates the medical plan denied the claim without forwarding it. Providers should actively follow up with the dental plan to confirm receipt, as automated forwarding between plans does not always succeed.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 291 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-291

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-291 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 291 may appear with different Group Codes:

Related Denial Codes