CARC 305 Active

OA-305: Claim Forwarded to Hearing Plan

TL;DR

The hearing claim was forwarded as part of COB processing. Monitor the hearing plan for adjudication.

Action

Verify & Resubmit

Who Pays

Depends

Appeal

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-305 Mean?

OA-305 appears when the claim forwarding occurs in a coordination of benefits context where the adjustment does not fall strictly under contractual obligation. The hearing services are being routed through the COB payer sequence, with the medical plan passing responsibility to the hearing plan as part of standard COB processing.

When CARC 305 appears on a remittance, the medical plan is telling you two things at once: hearing benefits are not available under the medical plan, and the medical plan has already taken the step of forwarding your claim to the patient's hearing plan. This is an informational code, not a traditional denial requiring provider action to redirect the claim.

The practical difference between CARC 305 and CARC 304 matters for your workflow. With CARC 304, you must identify the hearing plan and resubmit the claim yourself. With CARC 305, the medical plan's system automatically identified the hearing plan and forwarded the claim. Your responsibility shifts from claim submission to claim monitoring — you need to follow up with the hearing plan to confirm receipt and track adjudication.

The risk with CARC 305 is assuming the forwarded claim will process smoothly without follow-up. Automated forwarding can fail for various reasons: the hearing plan may not have the patient's current eligibility on file, the claim format may not meet the hearing plan's requirements, or the forwarded claim may get lost in the transfer. Proactive follow-up with the hearing plan is essential to ensure payment.

Common Causes

Cause	Frequency
Hearing services billed to medical plan The claim for hearing-related services was submitted to the patient's general medical insurance, which does not cover hearing benefits. Unlike CARC 304 where the provider must redirect the claim, here the medical plan automatically forwards it to the hearing plan	Most Common
Incorrect insurance information on file The patient's hearing plan details were not collected or were entered incorrectly during registration, causing the claim to initially go to the medical plan before being forwarded	Common
Coordination of benefits auto-routing The medical plan's claims processing system identified the services as hearing-related and automatically forwarded them to the patient's hearing plan as part of standard COB procedures	Common
Plan exclusions for hearing services The patient's medical plan explicitly excludes hearing services from its coverage, triggering automatic forwarding to the separate hearing benefit plan	Common
Eligibility or coverage gap on hearing plan The claim was forwarded to the hearing plan but may still be denied if the patient's hearing coverage has expired, is inactive, or does not cover the specific services rendered	Occasional

How to Resolve

Confirm the hearing plan received the forwarded claim, then monitor it through adjudication.

Verify the COB routing Confirm the claim was forwarded to the correct hearing plan in the COB sequence and that the hearing plan has it in their system.
Follow up with the hearing plan Track the forwarded claim and ensure it is processed within the hearing plan's standard timeframe.

Do Not Appeal This Code

This adjustment is typically correct as processed. Review the specific circumstances before taking further action.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-305:

RARC	Description
N130	Alert: You may need to review plan documents or guidelines for coverage details related to this service.
N381	Alert: Consult your contractual agreement for billing and payment information.

How to Prevent OA-305

Document all hearing plan payers in the COB sequence during patient registration to facilitate correct claim routing from the start

General Prevention

Collect complete insurance information including hearing plan details during patient registration to enable direct billing to the correct plan
Verify hearing plan eligibility and benefits before rendering hearing-related services
Bill hearing-related services directly to the hearing plan from the start to avoid unnecessary forwarding and processing delays
Maintain updated records of which insurers have separate hearing plans and which services are carved out from the medical plan
Track forwarded claims to ensure the hearing plan processes them within expected timeframes

Also Filed As

The same CARC 305 may appear with different Group Codes:

CO-305

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/305
https://x12.org/codes/claim-adjustment-reason-codes
Codes maintained by X12. Visit x12.org for official definitions.