CO-268: Claim Spans Two Calendar Years
The claim crosses two calendar years. Split it into two claims and resubmit — this is a formatting requirement, not a coverage issue.
What Does CO-268 Mean?
CO-268 is the standard pairing for this denial. The payer is applying a contractual requirement that claims must not span two calendar years. This is not a coverage denial — the services may be fully covered. The issue is purely the claim format. Once you split and resubmit, the claims should adjudicate normally.
When CARC 268 appears on a remittance, the payer rejected the claim because it contains dates of service that cross a calendar year boundary — for example, services from both December 2025 and January 2026 on a single claim form. Most payers require one claim per calendar year because their adjudication systems process deductibles, benefit accumulators, and fee schedules on a calendar-year basis. A claim that straddles the year boundary cannot be properly applied to the correct benefit period.
This denial occurs most frequently with long-term care facilities, inpatient stays that cross year-end, home health episodes, and any provider that bills for extended services. It also surfaces when billing staff batch year-end services with early-January services into a single claim. The fix is mechanical: split the claim into two separate submissions, each containing only the services and dates that fall within a single calendar year.
No appeal is necessary. CARC 268 is entirely a claim formatting requirement. Once you split the claim correctly and resubmit, both claims should process normally through the payer's system. The key prevention step is configuring your billing system to automatically detect and split claims at the calendar year boundary before submission.
Common Causes
| Cause | Frequency |
|---|---|
| Services from different calendar years on a single claim The claim includes dates of service that span from one calendar year into the next (e.g., December 2025 and January 2026), and the payer requires one claim per calendar year | Most Common |
| Billing system failure to auto-split by year The practice management or billing system did not automatically split the claim at the calendar year boundary before submission | Common |
| Inaccurate date-of-service documentation Service dates were entered incorrectly, causing the claim to appear to span two calendar years when it should not | Common |
| Late claim submission for year-end services Services provided near year-end were batched with early-January services and submitted as a single claim crossing the year boundary | Occasional |
How to Resolve
Split the claim into two separate submissions — one for each calendar year — and resubmit both with the correct dates of service.
- Split the claim at the year boundary Divide all services into two claims separated at December 31/January 1. Ensure charges, units, and dates are correctly allocated to each calendar year.
- Resubmit both claims separately Submit both claims individually. Include complete documentation with each claim.
- Monitor for timely filing Ensure the first-year claim is still within the timely filing window. If the year-end services are approaching the filing deadline, prioritize that submission.
This is a standard contractual adjustment. The amount is a provider write-off per your payer contract.
How to Prevent CO-268
- Configure billing systems to automatically split claims when dates of service span calendar year boundaries
- Submit claims promptly at year-end to avoid batching December and January services together
- Implement pre-submission validation rules that flag claims crossing the calendar year boundary
- Train billing staff to check date ranges on year-end claims before submission
General Prevention
- Submit claims promptly to avoid batching year-end and year-start services together
- Double-check dates of service on all claims for accuracy, especially for services near year-end
- Implement pre-submission validation rules that flag claims crossing calendar year boundaries
- Train billing staff on the requirement to submit separate claims per calendar year
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/268
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.