290Denial Code (CARC)Active
CARC 290 Denial Code - Forwarded to Medical Plan
Code 290 indicates that the claim was received by the dental plan but the benefits for the services are not available under this plan. Instead of being denied outright, the claim has been forwarded to the patient's medical plan for further review and consideration.
Who Pays: Group Code Liability
For code 290, the group code is typically CO, meaning the provider should write off the amount and not bill the patient. However, if the medical plan ultimately denies the claim and assigns PR, then the patient could be responsible.
Why Claims Get Code 290
- The patient has a dental plan that does not cover the submitted services.
- The services are potentially covered under the patient's medical plan instead.
- The claim was initially submitted under a dental policy incorrectly.
- The patient's benefit coordination was not set up correctly in the system.
How to Fix & Resubmit
- Verify the patient's insurance information to ensure correct plan submission.
- Check the patient's medical plan details to confirm if the services might be covered.
- Contact the medical plan to confirm receipt of the forwarded claim and inquire about status.
- If the medical plan denies coverage, review the denial reason for potential appeal or patient billing.
- Document the claim forwarding and any communications with the medical plan for records.
Corrected Claim or Appeal?
For code 290, a formal appeal is not usually required unless the medical plan denies the claim. If the medical plan denies it, check their denial reason and consider if an appeal is warranted.
Preventing Future 290 Denials
- Ensure accurate entry of the patient's insurance details, distinguishing between medical and dental plans.
- Verify benefit eligibility under the correct plan before submitting claims.
- Educate front-office staff on the importance of accurate benefit coordination.
- Regularly update the system with the latest patient insurance information.