280Denial Code (CARC)Active
CO 280 Denial Code - Fix Claim Submission Errors
Code 280 indicates that the claim was processed by the medical plan, but the services are not covered under this plan. Instead, the claim should be submitted to the patient's Pharmacy plan for evaluation.
Who Pays: Group Code Liability
With code 280, the group code typically used is CO, meaning the provider must write off the amount as a contractual obligation, and the patient cannot be billed for these services under their medical plan.
Why Claims Get Code 280
- The service was mistakenly billed to the medical plan instead of the pharmacy plan.
- The patient's benefits for the service fall under their pharmacy coverage, not medical.
- Incorrect payer was selected based on the type of service rendered.
- Patient's plan details were not thoroughly checked prior to claim submission.
How to Fix & Resubmit
- Verify the patient's pharmacy plan details to ensure correct submission.
- Contact the payer for clarification if the payer's information is unclear about the pharmacy plan.
- Resubmit the claim to the patient's Pharmacy plan with all required documentation.
- Ensure that the service provided is eligible under the patient's pharmacy benefits before resubmission.
Corrected Claim or Appeal?
For code 280, resubmitting the claim to the correct pharmacy plan is the appropriate action. An appeal is not necessary as this is not a denial but a misdirection of the claim.
Preventing Future 280 Denials
- Verify the patient's coverage details before claim submission to identify the correct plan.
- Use eligibility verification tools to check whether services should be billed to the medical or pharmacy plan.
- Train staff to recognize services that are typically covered under pharmacy plans.
- Regularly update payer information to ensure accurate claim submission.