268Denial Code (CARC)Active
CO 268 Denial Code: Fix Year-Span Claims
Code 268 indicates that the claim covers services provided across two different calendar years. The payer requires that you submit separate claims for each calendar year involved.
Who Pays: Group Code Liability
With code 268, the group code is typically CO, meaning the provider must adjust the claim and cannot bill the patient for the denied amount.
Why Claims Get Code 268
- The claim includes dates of service from December 31st and January 1st.
- Services were rendered over a period that crossed from one year into the next without splitting the claim.
- The billing system automatically generated a single claim for services spanning year-end.
- The provider overlooked the requirement to split claims at the year boundary.
How to Fix & Resubmit
- Review the denied claim to identify the dates of service involved.
- Verify that the claim indeed spans two calendar years.
- Split the claim into two separate claims, ensuring each claim covers only one calendar year.
- Submit the corrected claims separately for each calendar year.
- Follow up with the payer to ensure both claims are processed correctly.
Corrected Claim or Appeal?
For code 268, the correct course of action is to submit corrected claims. Appeals are not applicable since this is a technical requirement, not an error in judgment by the payer.
Preventing Future 268 Denials
- Implement a billing system check to flag claims spanning calendar years before submission.
- Train billing staff to manually review claims near year-end for date span issues.
- Establish a protocol to split claims at the year-end boundary automatically.
- Ensure that billing software is configured to alert when claims span multiple years.