CARC 289 Active

OA-289: Dental/Medical Plan Benefits Not Available

TL;DR

OA-289 means the claim is denied under both plans with unclear liability. Investigate whether the patient is responsible or if the balance should be written off.

Action

Review & Decide

Who Pays

Depends

Appeal

Yes

Patient Impact

Indirect

Disclaimer

This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does OA-289 Mean?

When CARC 289 appears with OA, the financial responsibility is not clearly assigned. This may indicate the payer is flagging the denial without assigning it to either the provider or the patient. The provider should investigate whether the patient can be billed for the service or whether the amount should be written off.

When CARC 289 appears on your remittance, the payer is communicating that the services billed have been evaluated under both the dental and medical plan benefit structures, and coverage is not available under either one. This code sits at the intersection of dental-medical coordination and is often triggered when a procedure could theoretically fall under either benefit type but the patient's specific plan design excludes it from both.

This denial frequently surfaces with procedures that straddle the dental-medical boundary, such as certain oral surgery procedures, TMJ treatments, or dental anesthesia services. The payer has determined that the dental plan does not cover the service, and the medical plan also does not provide benefits for it. Unlike CARC 290 or 291 where the claim is forwarded to the other plan, CARC 289 indicates that both avenues have been exhausted.

The financial impact depends heavily on the group code. With CO, the provider absorbs the cost. With OA, the responsibility may fall on the patient or require further investigation. Before writing off the balance, verify that the correct procedure and diagnosis codes were used, as coding adjustments may allow the claim to be reprocessed successfully under one of the plans. Related codes to be aware of include CARC 254, 270, and 280, which address similar cross-plan coverage scenarios.

Common Causes

Cause	Frequency
Service not covered under either plan The specific service or procedure is excluded from benefits under both the patient's dental and medical insurance plans	Most Common
Incorrect coding Healthcare provider used an incorrect code that is not covered under the patient's dental or medical plan	Common
Missing pre-authorization Some dental and medical plans require pre-authorization for certain services, and failure to obtain it results in denial	Common
Policy exclusions Specific policy exclusions in both dental and medical plans deny coverage for the service rendered	Common
Coordination of benefits issues Problems when patients hold multiple plans and benefits determination between dental and medical coverage fails	Common
Coverage limits exceeded The patient has exceeded the maximum benefit limits under both dental and medical plans for the services rendered	Occasional

How to Resolve

Verify coding accuracy, confirm coverage exclusions under both plans, and either appeal with medical necessity documentation or inform the patient of their financial responsibility.

Clarify liability Contact the payer to determine whether the balance can be billed to the patient or must be written off by the provider.
Bill the patient if appropriate If the payer confirms the patient is responsible, issue a patient statement with an explanation of why the insurance did not cover the service.

How to Prevent OA-289

Verify benefit coverage under all applicable plans before providing services
Collect financial consent from patients for services that may not be covered

General Prevention

Verify eligibility and benefits under both dental and medical plans before rendering services
Obtain necessary pre-authorizations from both plans when required
Document medical necessity thoroughly to support cross-plan coverage arguments
Stay current with policy changes for both dental and medical plan coverage
Train billing staff on proper coordination of benefits between dental and medical plans

Also Filed As

The same CARC 289 may appear with different Group Codes:

CO-289

Related Denial Codes

OA-23 — Impact of Prior Payer Adjudication OA-32 — Patient Not Eligible as Dependent OA-35 — Lifetime Benefit Maximum Reached OA-49 — Routine/Preventive Exam Not Covered OA-78 — Non-Covered Days / Room Charge Adjustment

Sources

https://www.mdclarity.com/denial-code/289
https://x12.org/codes/claim-adjustment-reason-codes
Codes maintained by X12. Visit x12.org for official definitions.