Denial Code 298 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 vision plan for further consideration. In this article, we will provide a description of denial code 298, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code 298 cases.
2. Description
Denial Code 298 is a claim adjustment reason code that indicates the claim has been received by the medical plan, but the benefits are not available under this specific plan. The claim has been forwarded to the patient’s vision plan for further consideration. This denial code typically occurs when the services or procedures being claimed are not covered by the medical plan but may be covered under a separate vision plan.
2. Common Reasons
The most common reasons for denial code 298 are:
- Limited Coverage: Denial code 298 often occurs when the medical plan has limited coverage for certain services or procedures. These services may fall under the scope of a separate vision plan, which is why the claim is forwarded for further consideration.
- Incorrect Billing: Sometimes, denial code 298 can be triggered due to incorrect billing. This could include coding errors or billing for services that are not covered by the medical plan but may be covered by the patient’s vision plan.
- Lack of Coordination: In cases where a patient has both a medical plan and a vision plan, a lack of coordination between the two plans can lead to denial code 298. If the services being claimed are covered by the vision plan but not the medical plan, the claim will be forwarded for consideration by the vision plan.
3. Next Steps
To resolve denial code 298, the following steps can be taken:
- Contact the Vision Plan: Reach out to the patient’s vision plan to inquire about the coverage for the services or procedures being claimed. Provide them with the necessary information and documentation to support the claim.
- Coordinate with the Medical Plan: Communicate with the medical plan to ensure that they have forwarded the claim to the vision plan for consideration. Confirm that the claim has been properly submitted and provide any additional information requested by the vision plan.
- Follow Up: Regularly follow up with both the medical plan and the vision plan to track the progress of the claim. Stay in touch with the patient to keep them informed about the status of their claim and any actions they may need to take.
- Appeal if Necessary: If the claim is denied by the vision plan, review the denial reason and determine if an appeal is warranted. Gather any additional supporting documentation and submit an appeal to the vision plan for reconsideration.
4. How To Avoid It
To avoid denial code 298 in the future, consider the following tips:
- Verify Coverage: Before providing services or procedures, verify the patient’s coverage under both the medical plan and the vision plan. Ensure that the services being provided are covered by the appropriate plan to avoid potential denials.
- Coordinate Benefits: If a patient has both a medical plan and a vision plan, ensure that the benefits are properly coordinated. Understand which plan covers which services and procedures to avoid confusion and potential denials.
- Accurate Billing: Double-check all billing information to ensure accuracy. Use the correct codes and clearly indicate the services or procedures being claimed. This will help prevent denials due to incorrect billing.
- Clear Communication: Educate patients about their insurance coverage and the coordination of benefits between their medical plan and vision plan. Clearly explain which services are covered by each plan and any potential out-of-pocket expenses they may incur.
5. Example Cases
Here are two examples of denial code 298:
- Example 1: A patient submits a claim for an eye exam to their medical plan. However, the medical plan does not cover routine eye exams. The claim is then forwarded to the patient’s vision plan for further consideration.
- Example 2: A patient undergoes a cataract surgery that is covered by their medical plan. However, the vision plan covers the cost of the intraocular lens used during the surgery. The claim for the intraocular lens is forwarded to the vision plan for consideration.
