OA-297: Medical Plan Claim — Submit to Vision Plan
OA-297 means the medical plan says to submit to the vision plan. If the patient has no vision coverage, they may be financially responsible.
What Does OA-297 Mean?
When CARC 297 appears with OA, the medical plan is directing the provider to submit to the vision plan without assigning financial responsibility. The provider should submit to the vision plan, and if no vision coverage exists, the patient may be responsible for the balance.
CARC 297 indicates the medical plan received the claim, determined that benefits are not available under the medical benefit, and is directing the provider to submit the claim to the patient's vision plan instead. Unlike CARC 298 (which indicates the medical plan forwarded the claim automatically), CARC 297 places the resubmission responsibility on the provider.
This code appears for vision-related services such as routine eye exams, refractions, contact lens fittings, and eyewear that were billed to the medical plan. Many patients have separate vision insurance through carriers like VSP, EyeMed, or Davis Vision, and the medical plan does not cover services that fall within the vision benefit scope. The medical plan is telling you that the service is not their responsibility and directing you to the correct payer.
The critical action item with CARC 297 is that you must actively resubmit the claim to the vision plan. The medical plan has not forwarded it on your behalf. If you do not resubmit, the claim will remain unpaid. You need the patient's vision plan information including the payer ID, group number, and member ID to submit correctly. Some services, such as medical eye conditions like glaucoma or diabetic retinal exams, may be covered under the medical plan if billed with the appropriate medical diagnosis codes.
Common Causes
| Cause | Frequency |
|---|---|
| Service classified as vision rather than medical The medical plan determined the service is a vision benefit and should be processed through the patient's vision insurance plan | Most Common |
| Claim submitted to wrong plan Provider submitted a vision-related service to the medical plan instead of the vision plan | Common |
| Plan-specific coverage exclusions Medical plan specifically excludes vision services like routine eye exams, refraction, or eyewear | Common |
| Missing medical necessity documentation Service could be covered under medical if medically necessary but documentation was not provided to support medical coverage | Common |
| Coverage limits reached Medical plan benefits for vision-related services have been exhausted for the benefit period | Occasional |
How to Resolve
Obtain the patient's vision plan information and submit the claim directly to the vision plan.
- Submit to vision plan or bill patient If the patient has a vision plan, submit there. If not, the patient may be responsible for the service cost.
How to Prevent OA-297
- Identify whether patients have separate vision coverage during intake to avoid routing delays
General Prevention
- Verify patient insurance coverage and determine whether the service falls under medical or vision benefits before submission
- Identify whether the patient has a separate vision plan during registration
- Use diagnosis codes that support medical necessity when billing vision services to the medical plan
- Train billing staff on the distinction between medical and vision plan coverage for eye-related services
Also Filed As
The same CARC 297 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/297
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.