How To Fix Denial Code 291 | Common Reasons, Next Steps & How To Avoid It

Denial Code 291 means that a claim has been received by the medical plan, but benefits are not available under this plan. The claim has been forwarded to the patient’s dental plan for further consideration. In this article, we will provide a detailed description of denial code 291, common reasons for its occurrence, next steps to resolve it, tips on how to avoid it in the future, and examples of denial code 291 cases.

2. Description

Denial Code 291 is a claim adjustment reason code (CARC) that indicates the medical plan has received the claim but does not provide benefits for the services or procedures billed. Instead, the claim is forwarded to the patient’s dental plan for further evaluation and consideration. This denial code typically occurs when a patient’s medical plan does not cover dental services, and the claim needs to be redirected to the appropriate dental insurance provider.

2. Common Reasons

The most common reasons for denial code 291 are:

1. Lack of Dental Coverage: Denial code 291 often arises when the patient’s medical plan does not include dental coverage. Since the claim involves dental services, the medical plan cannot provide benefits and must forward the claim to the dental plan for review.
2. Incorrect Billing: In some cases, denial code 291 may occur due to billing errors. This could include incorrect coding or incorrect identification of the services as dental procedures instead of medical procedures. Such errors can lead to the claim being sent to the wrong plan, resulting in denial.
3. Coordination of Benefits: Denial code 291 may also occur when there is a lack of coordination between the medical and dental insurance plans. If the patient has both medical and dental coverage, but the coordination of benefits is not properly established, the claim may be forwarded to the dental plan for consideration.

3. Next Steps

To resolve denial code 291, the following steps can be taken:

1. Contact Dental Insurance Provider: Reach out to the patient’s dental insurance provider to inform them about the forwarded claim. Provide any necessary documentation or information required by the dental plan for their review.
2. Follow Up with Dental Plan: Regularly follow up with the dental plan to ensure that the claim is being processed and reviewed in a timely manner. This will help to expedite the resolution of the claim and prevent any delays in payment.
3. Review Coordination of Benefits: If the patient has both medical and dental coverage, it is important to review the coordination of benefits between the two plans. Ensure that the necessary information is provided to both plans to avoid any future denials or delays in processing claims.
4. Appeal if Necessary: If the dental plan denies the claim or does not provide the expected benefits, it may be necessary to appeal the decision. Gather any supporting documentation or evidence to support the claim and submit an appeal to the dental plan for reconsideration.

4. How To Avoid It

To avoid denial code 291 in the future, consider the following tips:

1. Verify Dental Coverage: Before providing any dental services, verify the patient’s dental coverage to ensure that the services will be covered by their insurance plan. This can help prevent the need for forwarding claims to a different plan.
2. Accurate Billing: Ensure that all claims are accurately coded and billed. Double-check the identification of services as dental or medical procedures to avoid any confusion or misdirection of claims.
3. Establish Coordination of Benefits: If the patient has both medical and dental coverage, establish proper coordination of benefits between the two plans. This will help ensure that claims are processed correctly and avoid unnecessary denials or delays.
4. Education and Communication: Educate patients about their insurance coverage and the limitations of their plans. Clearly communicate any potential issues or requirements related to dental services to manage their expectations and prevent surprises or misunderstandings.

5. Example Cases

Here are two examples of denial code 291:

• Example 1: A patient submits a claim for a dental procedure to their medical plan, unaware that dental services are not covered. The medical plan forwards the claim to the patient’s dental insurance provider for further consideration.
• Example 2: A billing error occurs, and a dental claim is mistakenly submitted to the patient’s medical plan instead of their dental plan. The medical plan denies the claim and forwards it to the dental plan for review.

Source: Claim Adjustment Reason Codes