PR-300: Medical Plan Benefits Not Available - Submit to Behavioral Health

What Does PR-300 Mean?

When paired with Group Code PR, CARC 300 shifts the financial responsibility to the patient. The adjustment for medical plan benefits not available - submit to behavioral health is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

CARC 300 is a claim routing code indicating the medical plan received the claim, determined the service belongs under behavioral health coverage, and has automatically forwarded it to the patient's behavioral health plan for processing. This code is a forwarding confirmation, not a final denial.

This code is common in managed care arrangements where behavioral health benefits are carved out and managed by a separate entity. Many employers and health plans contract with specialty behavioral health organizations like Optum Behavioral Health, Carelon Behavioral Health, or Magellan to administer mental health and substance abuse benefits separately from medical/surgical benefits. When a provider submits a behavioral health claim to the medical plan, the medical plan recognizes the service type and routes it to the carved-out behavioral health administrator.

The distinction between CARC 300 and CARC 301 is important. CARC 300 means the medical plan has forwarded the claim to the behavioral health plan on your behalf. CARC 301 means the medical plan is telling you to submit the claim to the behavioral health plan yourself. With CARC 300, the claim should already be in the behavioral health plan's queue, but active follow-up is still recommended to ensure the forwarding was successful.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 300 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-300

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-300 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 300 may appear with different Group Codes:

Related Denial Codes