OA-304: Benefits Not Available — Submit to Hearing Plan

What Does OA-304 Mean?

OA-304 appears in coordination of benefits scenarios where the medical plan is routing the hearing services to another plan in the benefits sequence. This may occur when multiple payers are involved and the hearing benefit responsibility is being directed to a specific payer in the COB chain rather than the medical plan.

When CARC 304 appears on a remittance, the medical plan is informing you that the services billed — typically audiological exams, hearing aid fittings, or hearing-related procedures — are not covered under the patient's general medical insurance. Instead, these services must be submitted to the patient's separate hearing benefit plan for adjudication.

Many commercial insurance carriers carve out hearing benefits into separate specialty plans administered by different entities. When a hearing-related claim is submitted to the medical plan, the medical plan cannot process it because the benefits exist under a different plan with a different payer ID and billing pathway. CARC 304 specifically instructs the provider to submit the claim to the hearing plan rather than simply denying it.

The key distinction between CARC 304 and CARC 305 is important: CARC 304 tells you to submit the claim yourself to the hearing plan, while CARC 305 means the medical plan has already forwarded the claim to the hearing plan on your behalf. When you receive CARC 304, the ball is in your court to identify the correct hearing plan payer and resubmit.

How to Resolve

Identify the patient's hearing plan and resubmit the claim directly to that payer.

1. Review the COB payer sequence Identify all payers covering the patient and determine which one administers the hearing benefits.
2. Submit to the correct payer File the claim with the hearing plan identified in the COB sequence, attaching the medical plan's remittance showing the OA-304 adjustment.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-304:

How to Prevent OA-304

• Verify hearing benefit coverage across all payers in the COB sequence during patient registration
• Document the correct billing order for hearing versus medical services in the patient's account

Also Filed As

The same CARC 304 may appear with different Group Codes:

Related Denial Codes