PR-268: Claim Spans Two Calendar Years

What Does PR-268 Mean?

When paired with Group Code PR, CARC 268 shifts the financial responsibility to the patient. The adjustment for claim spans two calendar years is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

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. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 268 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-268

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-268 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 268 may appear with different Group Codes:

Related Denial Codes