PR-298: Medical Plan Benefits Not Available - Forwarded to Vision

What Does PR-298 Mean?

When paired with Group Code PR, CARC 298 shifts the financial responsibility to the patient. The adjustment for medical plan benefits not available - forwarded to vision is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

CARC 298 is a claim routing code indicating the medical plan received the claim, determined the service falls under vision benefits, and has automatically forwarded the claim to the patient's vision plan for processing. Unlike CARC 297 where the provider must resubmit manually, CARC 298 means the medical plan has taken the forwarding action.

This code appears for the same types of services as CARC 297 — routine eye exams, refractions, eyewear fittings, and other vision-specific services that the medical plan excludes from coverage. The difference is purely in the forwarding mechanism: with CARC 298, the payer has handled the routing. However, providers should not assume the forwarding was successful. Electronic claim routing between plans does not always work smoothly, and claims can get lost in the handoff.

The provider's primary responsibility after receiving CARC 298 is to follow up with the vision plan to confirm receipt of the forwarded claim. If the vision plan has no record of the claim after 7-10 business days, the provider should submit the claim directly to the vision plan rather than waiting for the medical plan's forwarding to complete.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 298 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-298

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-298 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 298 may appear with different Group Codes:

Related Denial Codes