CARC 305 Active

PR-305: Medical Plan Claim — Forwarded to Hearing Plan

TL;DR

Unusual combination. Verify the hearing plan received and is processing the forwarded claim.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does PR-305 Mean?

PR with CARC 305 is uncommon since the medical plan has already forwarded the claim. If this appears, verify the hearing plan's adjudication status.

CARC 305 is an informational code indicating the medical plan has already taken action on the provider's behalf. Unlike CARC 304 (which tells you to submit to the hearing plan), CARC 305 confirms the medical plan has already forwarded the claim to the hearing plan. The medical plan recognized the service as hearing-related, denied its own coverage, and automatically routed the claim.

This auto-forwarding typically occurs when the medical plan and hearing plan have an integrated relationship with automatic claim routing configured. While no resubmission is necessary, the provider should monitor the hearing plan for adjudication and follow up if payment is not received within a reasonable timeframe.

How to Resolve

  1. Verify the claim was successfully forwarded to the hearing plan
  2. Contact the hearing plan to confirm they received the claim
  3. If the hearing plan denies, review coverage and next steps
Do Not Appeal This Code

Medical Plan Claim — Forwarded to Hearing Plan grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-305

Also Filed As

The same CARC 305 may appear with different Group Codes:

CO-305 OA-305

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.cms.gov/medicare/payment/prospective-payment-systems
  3. Codes maintained by X12. Visit x12.org for official definitions.