305Denial Code (CARC)Active
Denial Code OA 305: Claim Forwarded to Hearing Plan
Code 305 indicates that the claim was received by the patient's medical plan, but the benefits for the service are not available under that plan. Instead, the claim has been forwarded to the patient's hearing plan for further processing.
Who Pays: Group Code Liability
Under code 305, the group code OA typically applies, as the claim is being redirected rather than denied outright. The patient should not be billed until the hearing plan processes the claim.
Why Claims Get Code 305
- The service provided is covered under a separate hearing plan rather than the patient's medical plan.
- The patient's insurance benefits are split between medical and hearing plans, and the claim was initially sent to the wrong plan.
- The claim was submitted with a payer ID that corresponds to the medical plan instead of the hearing plan.
How to Fix & Resubmit
- Verify that the patient's coverage includes a separate hearing plan.
- Contact the hearing plan to confirm receipt of the forwarded claim and inquire about processing timelines.
- If the hearing plan did not receive the claim, resubmit it directly to the correct plan using the appropriate payer ID.
- Document any communication with both plans for record-keeping and follow-up.
Corrected Claim or Appeal?
For code 305, no appeal or corrected claim is necessary unless the hearing plan does not receive the forwarded claim. In that case, direct resubmission to the hearing plan is required.
Preventing Future 305 Denials
- Ensure the patient's benefits are verified and correctly categorized between medical and hearing plans at registration.
- Use the correct payer ID for the hearing plan when initially submitting claims related to hearing services.
- Train staff to recognize when services are covered by separate plans to avoid initial submission errors.