How do I resolve a CO-280 denial?

Review the full denial on the 835 ERA for CARC 280: "Claim received by the medical plan, but benefits not available under this plan." Pull the original claim and all supporting documentation for the date of service. See full resolution steps at tryarceum.com.

Can I appeal a CO-280 denial?

CO-280 denials are generally not appealable. This is a contractual routing issue, not a coverage denial; the claim was submitted to the wrong benefit plan and must be redirected to pharmacy benefits.

CARC Code

280

🟡 Soft Denial

Wrong Plan - Pharmacy Benefits

The medical insurance plan received your claim, but the services you billed should be covered under the patient's pharmacy benefits instead. You need to resubmit the claim to the patient's pharmacy benefit manager or prescription drug plan.

contractual

Resolution: 85%Easy difficulty3-7 days avg

How to resolve this denial

Which payer denied this claim?

Review and resolve CARC 280: Claim received by the medical plan, but benefits not available under this plan.

1
Review the full denial on the 835 ERA for CARC 280: "Claim received by the medical plan, but benefits not available under this plan."
2
Pull the original claim and all supporting documentation for the date of service.
3
Identify the specific data element, policy requirement, or documentation gap that triggered this adjustment.
4
Correct the identified issue — update claim data, gather missing documentation, or verify coverage details.
5
Resubmit as a corrected claim (frequency type 7) or file a written appeal with supporting documentation.
6
Follow up with the payer within 10-15 business days to confirm adjudication.

Resolve this denial →

▶✓ Pre-action checklist — verify before contacting the payer

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-280 — stats, related codes, appeal template

85%

Recovery Rate

3-7 days

Avg. Resolution

Easy

Difficulty

Rare

Frequency

Payer-Specific Notes

How major payers handle CARC 280 by specialty.

General

Confirm payer-specific policy for CARC 280 and submit corrected claim or appeal as appropriate.

Appeal Letter Template

Generic appeal template for CARC 280 denials.

Dear [Payer Name] Appeals Department, We are writing to appeal the denial of claim [CLAIM #] for patient [PATIENT NAME] (Member ID: [ID]) for services rendered on [DATE OF SERVICE]. The claim was denied with CARC 280: "Claim received by the medical plan, but benefits not available under this plan." We believe this denial is in error for the following reasons: [INSERT CLINICAL/ADMINISTRATIVE JUSTIFICATION] We respectfully request reconsideration and payment of this claim. Sincerely, [Provider Name / Billing Contact]

Generate a personalized appeal letter →

Need to resolve this denial?

Get a step-by-step resolution plan with payer-specific guidance and appeal letter generation.

Resolve this denial →

Was this helpful?

← Back to Code Library Automate denial follow-up →