Denial Code 268 means that a claim has been denied because it spans two calendar years. The insurance company requires claims to be submitted separately for each calendar year. In this article, we will provide a detailed description of denial code 268, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code 268 cases.
2. Description
Denial Code 268 is a Claim Adjustment Reason Code (CARC) that indicates a claim has been denied because it spans two calendar years. Insurance companies typically require claims to be submitted separately for each calendar year. This means that if a claim includes services or expenses that occurred in different years, it will be denied under denial code 268. The insurance company expects providers to split the claim into separate submissions based on the calendar year in which the services were rendered.
2. Common Reasons
The most common reasons for denial code 268 are:
- Claims Crossing Calendar Years: Denial code 268 occurs when a claim includes services or expenses that span two different calendar years. This can happen when a patient receives treatment or services towards the end of one year and continues into the next year. If the claim is not split into separate submissions for each calendar year, it will be denied under denial code 268.
- Incorrect Date of Service: Another reason for denial code 268 is when the date of service on the claim is incorrect or does not align with the calendar year in which the services were rendered. This can happen due to clerical errors or misunderstandings regarding the correct date of service.
- Lack of Awareness: Providers may be unaware of the requirement to split claims that span multiple calendar years. This lack of knowledge can lead to the submission of claims that are subsequently denied under denial code 268.
3. Next Steps
To resolve denial code 268, follow these next steps:
- Review Claim Dates: Carefully review the dates of service on the denied claim. Identify if the claim includes services or expenses that span two different calendar years.
- Split the Claim: If the claim spans multiple calendar years, split it into separate submissions for each year. Create separate claims for the services rendered in each calendar year.
- Resubmit the Claims: Once the claim has been split, resubmit each claim separately for the respective calendar year. Ensure that all necessary information and documentation are included in each claim submission.
- Follow Up: Monitor the status of the resubmitted claims and follow up with the insurance company to ensure they are processed correctly. Address any further denials or issues promptly.
4. How To Avoid It
To avoid denial code 268 in the future, consider the following tips:
- Stay Informed: Familiarize yourself with the insurance company’s requirements regarding claims that span multiple calendar years. Understand the need to split such claims into separate submissions.
- Double-Check Dates: Verify the accuracy of the dates of service on the claim before submission. Ensure that the dates align with the correct calendar year in which the services were rendered.
- Train Staff: Educate your billing and administrative staff about the requirement to split claims that span multiple calendar years. Provide training on how to identify and handle such claims appropriately.
- Use Clear Documentation: Maintain clear and accurate documentation of the dates of service for each claim. This will help ensure that claims are submitted correctly and avoid denials under denial code 268.
5. Example Cases
Here are two examples of denial code 268:
- Example 1: A patient undergoes a surgical procedure on December 28, 2021, and continues to receive follow-up care in January 2022. If the provider submits a single claim for all the services, it will be denied under denial code 268. The provider should split the claim into two separate submissions, one for each calendar year.
- Example 2: A patient receives physical therapy sessions from November 2021 to February 2022. If the provider submits a single claim for all the sessions, it will be denied under denial code 268. The provider should split the claim into two separate submissions, one for the sessions in 2021 and another for the sessions in 2022.
