PR-267: Claim/Service Spans Multiple Months

What Does PR-267 Mean?

When paired with Group Code PR, CARC 267 shifts the financial responsibility to the patient. The adjustment for claim/service spans multiple months is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

When CARC 267 appears on a remittance, the payer is flagging that the dates of service on your claim cross from one calendar month into another — and the claim does not include the required remark code to accompany a multi-month service. This is a technical formatting denial, not a clinical or coverage issue. The payer's adjudication system requires either a specific remark code (NCPDP Reject Reason Code or a non-ALERT Remittance Advice Remark Code) on multi-month claims, or it requires you to split the claim into separate monthly submissions.

This code surfaces most frequently with long-term care facilities, home health agencies, behavioral health providers, and any practice that bills for services spanning weeks or months — such as rental DME, ongoing therapy courses, or residential treatment programs. The root cause is almost always a billing system configuration issue: the system either failed to attach the required remark code or did not automatically split the claim at month boundaries.

The resolution is straightforward but varies by payer. Some payers accept multi-month claims when accompanied by the proper remark code. Others require one claim per calendar month regardless. Check the specific payer's billing guidelines to determine which approach to take, then correct and resubmit. No appeal is necessary since this is a formatting requirement, not a coverage dispute.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 267 adjustment. Review the remittance advice and any RARC codes for context.
2. Review for potential errors Check whether the underlying denial reason can be corrected, which may eliminate the patient's responsibility. Verify coding accuracy and documentation completeness.
3. Appeal if designation is incorrect If the PR assignment appears incorrect or the denial is in error, file an appeal with supporting documentation before billing the patient.
4. Generate patient statement If the determination is correct, generate a patient statement for the amount and follow standard patient collection procedures.
5. Communicate with the patient Explain the charge to the patient, provide information about their financial responsibility, and discuss payment options.

How to Prevent PR-267

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-267 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 267 may appear with different Group Codes:

Related Denial Codes