OA-268: Claim Spans Two Calendar Years

What Does OA-268 Mean?

When paired with Group Code OA, CARC 268 typically appears in a secondary payer or coordination of benefits context. The adjustment for claim spans two calendar years is being processed through COB rules. The financial responsibility depends on the specific coordination arrangement between payers.

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.

How to Resolve

1. Review the coordination of benefits Examine the OA-268 adjustment and determine how it fits within the primary/secondary payer relationship.
2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
3. Determine appropriate action Based on the COB review, decide whether to accept the adjustment, submit additional documentation, or file an appeal with the secondary payer.
4. Follow up Monitor the claim and take additional action as needed based on the COB determination.

How to Prevent OA-268

• Maintain current coordination of benefits information for patients with multiple insurance plans
• Submit complete documentation including primary payer EOBs when filing secondary claims
• Verify secondary payer requirements before claim submission
• Track OA adjustment patterns to identify systemic COB issues

Also Filed As

The same CARC 268 may appear with different Group Codes:

Related Denial Codes