Denial Code CO 298: Vision Plan Forwarding

Why Claims Get Code 298

• The patient has medical and vision coverage, but the service is only covered under the vision plan.
• The provider submitted the claim to the medical plan instead of the vision plan.
• The patient's vision benefits were not verified prior to claim submission.
• The service rendered falls outside the scope of the medical plan's coverage.
• Coordination of benefits was not correctly established, leading to misrouting.

How to Fix & Resubmit

1. Verify the patient's vision coverage details and ensure the claim was forwarded correctly.
2. Contact the vision plan to confirm receipt and processing status of the forwarded claim.
3. If the vision plan denies the claim, obtain the denial reason and consider resubmitting or appealing based on their feedback.
4. Ensure coordination of benefits is correctly set up to prevent future routing issues.
5. Document any communication with the payer for reference in case of further disputes.

Preventing Future 298 Denials

• Always verify both medical and vision benefits before submitting claims.
• Ensure the claim is submitted to the correct payer initially based on the type of service.
• Maintain up-to-date coordination of benefits information for each patient.
• Educate the billing team on the differences between medical and vision plan coverages.