289Denial Code (CARC)Active
CO 289 Denial Code: Dental/Medical Plan Benefits Not Available
Code 289 means the payer evaluated the services under both the dental and medical plans but determined that no benefits are available under either plan. This typically indicates coverage issues or plan exclusions for the services billed.
Who Pays: Group Code Liability
For code 289, the liability usually falls under CO, meaning the provider must write off the amount and cannot bill the patient. However, if the payer's policy specifies otherwise, check for any PR applicability to ensure compliance.
Why Claims Get Code 289
- The patient's plan does not cover the specific service under either medical or dental benefits.
- The service was billed to the wrong plan type, such as medical instead of dental.
- The patient has exhausted their dental or medical benefits for the service.
- The service is excluded under both the dental and medical plans.
- Coordination of benefits was incorrectly processed, leading to denial.
How to Fix & Resubmit
- Verify the patient's benefits to confirm if the service should be covered under either dental or medical plans.
- Check if the service was billed to the correct plan type and resubmit if necessary.
- Review the patient's benefit limits and any exclusions for the service.
- Contact the payer for clarification on why benefits are not available and whether a corrected claim is possible.
- If necessary, submit a corrected claim with the appropriate plan or service details.
Corrected Claim or Appeal?
When code 289 appears, first verify if the denial is due to a billing error. If it's a contractual denial, no appeal is possible. Submit a corrected claim if the service was billed to the wrong plan.
Preventing Future 289 Denials
- Ensure accurate verification of patient benefits before service delivery, especially distinguishing between dental and medical plans.
- Train staff to confirm plan type and coverage details during patient registration.
- Implement checks to prevent billing services to the wrong plan type.
- Regularly update staff on payer-specific benefits and exclusions to minimize errors.