297Denial Code (CARC)Active
CO 297 Denial Code - Vision Plan Submission Fix
Code 297 indicates that the claim was received by the medical plan, but the services are not covered under the patient's current medical benefits. Instead, these services should be submitted to the patient's vision plan for coverage consideration.
Who Pays: Group Code Liability
For code 297, the group code is typically CO, meaning the provider should write off the amount. The patient should not be billed as it is a contractual obligation.
Why Claims Get Code 297
- The services were submitted to the medical plan instead of the vision plan.
- The patient's insurance information was incorrectly entered, leading to submission to the wrong plan.
- The claim was not properly coded to reflect a vision-related service.
- The patient's vision benefits were not verified before claim submission.
- Coordination of benefits was not correctly applied, leading to submission to the wrong plan.
How to Fix & Resubmit
- Verify the patient's insurance coverage to determine the correct vision plan information.
- Review the claim to ensure it was coded correctly for vision services.
- Contact the patient's vision plan to confirm the correct submission process and any necessary pre-authorization.
- Submit a new claim to the patient's vision plan with the correct coding and insurance details.
- Document the corrected submission details in the patient's file for future reference.
Corrected Claim or Appeal?
For code 297, a corrected claim should be submitted to the patient's vision plan rather than appealing the original denial. Appeals are not applicable as this is a submission error, not a denial of covered benefits.
Preventing Future 297 Denials
- Verify patient insurance details, including vision coverage, during registration.
- Ensure claims are coded correctly for the type of service provided, distinguishing medical from vision services.
- Train staff on the importance of accurately identifying the appropriate plan for submission.
- Implement a process to verify coordination of benefits before claim submission.