304Denial Code (CARC)Active
CO 304 Denial Code - Benefits Not Available, Next Steps
CARC 304 means the claim was sent to the medical plan, but the services are not covered under that plan. Instead, the claim should be submitted to the patient's hearing plan for processing.
Who Pays: Group Code Liability
With CARC 304, the group code is typically CO, making it a contractual write-off, as the claim needs to be resubmitted to the correct plan. The patient should not be billed for this denial.
Why Claims Get Code 304
- The claim was mistakenly submitted to the medical plan instead of the hearing plan.
- The patient has dual coverage, and the hearing services were not billed to the correct plan.
- The provider's billing system has incorrect plan information for the patient.
- Coordination of benefits information was not updated, leading to the wrong plan being billed.
How to Fix & Resubmit
- Verify the patient's insurance details to confirm the correct plan for hearing services.
- Check your billing system to ensure the correct plan information is listed for the patient.
- Submit the claim to the patient's hearing plan as indicated by the denial.
- Follow up with the hearing plan to confirm receipt and processing of the claim.
Corrected Claim or Appeal?
For CARC 304, a corrected claim should be submitted to the patient's hearing plan. An appeal is not appropriate in this scenario as the denial is due to billing the wrong plan.
Preventing Future 304 Denials
- Verify the patient's insurance coverage at each visit to ensure claims go to the correct plan.
- Update coordination of benefits information promptly when notified of changes.
- Train staff to recognize and correctly handle plans that cover specific services like hearing.
- Ensure billing software is programmed to check for correct plan submission based on service type.