OA-239: Claim Spans Eligible and Ineligible Periods — Rebill

What Does OA-239 Mean?

OA-239 is used when the claim spanning issue involves coordination between multiple payers, such as when the patient transitioned between insurance plans during the service period.

CARC 239 is a rebilling instruction, not a permanent denial. The payer has identified that your claim's dates of service cross a coverage boundary — part of the period was covered and part was not — but instead of processing the eligible portion (as with CARC 238), the payer is returning the entire claim and asking you to split it into separate submissions.

This code appears when the payer cannot or will not perform the date-splitting on their end. The provider must identify the exact date where coverage changes, create one claim for the eligible period and another for the ineligible period, and submit them separately. The eligible-period claim goes to the payer for normal processing. The ineligible-period claim goes to whatever coverage was active during that time, or to the patient if no coverage existed.

CARC 239 typically appears with CO (the entire claim is rejected as a contractual requirement to rebill correctly) or OA (when the situation involves coordination between multiple payers). The key difference from CARC 238: with 238 the payer has already made the split and paid the eligible portion; with 239 you have to do the splitting yourself.

How to Resolve

Identify the coverage boundary date, split the claim into separate submissions for each period, and rebill to the appropriate payer for each period.

1. Identify all active payers Determine which payer was responsible during each portion of the claim's date range. The patient may have transitioned between plans or had a gap followed by new coverage.
2. Submit to appropriate payers Split the claim and submit each segment to the payer that was active during that period. Include COB information as needed.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-239:

How to Prevent OA-239

• Collect comprehensive insurance information from patients including effective dates for all active and recent plans
• Verify which payer is primary for each date of service in multi-payer situations

Also Filed As

The same CARC 239 may appear with different Group Codes:

Related Denial Codes