OA-267: Claim Spans Multiple Months
Multi-month claim adjustment under other adjustment. Correct the format and resubmit or forward to the appropriate payer.
What Does OA-267 Mean?
OA-267 may appear when the multi-month claim involves coordination between payers or when the payer applies the adjustment outside standard contractual categories. The same resolution applies — correct the claim format and resubmit.
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.
Common Causes
| Cause | Frequency |
|---|---|
| Service spans multiple calendar months on a single claim The claim was submitted with dates of service that cross from one calendar month into the next, and the payer requires separate claims for each month | Most Common |
| Missing required remark code The claim spans multiple months but did not include the required remark code (NCPDP Reject Reason Code or Remittance Advice Remark Code that is not an ALERT) to accompany the multi-month service | Most Common |
| Incomplete documentation for extended services Missing treatment plans, progress notes, or other documentation that demonstrates the medical necessity of services spanning multiple months | Common |
| Incorrect service date formatting The date-of-service range on the claim was entered incorrectly, making it appear to span multiple months when it should not | Common |
| Payer-specific multi-month billing requirements not met The payer has specific guidelines for billing multi-month services that the provider did not follow, such as requiring specific modifiers or claim formats | Occasional |
How to Resolve
Determine whether the payer requires a remark code on multi-month claims or separate monthly claims, then correct the submission format and resubmit.
- Determine if the adjustment involves payer coordination Check whether the OA-267 adjustment is related to coordination of benefits or a secondary payer routing issue.
- Correct and resubmit Add the required remark code or split the claim by month. If a secondary payer is involved, submit to the next payer with the primary remittance.
This adjustment is typically correct as processed. Review the specific circumstances before taking further action.
How to Prevent OA-267
- Verify insurance coordination details at intake to ensure multi-month claims are routed to the correct primary payer
- Apply the same monthly claim splitting rules regardless of payer type
General Prevention
- Split claims by calendar month before submission when payer guidelines require monthly billing
- Include required remark codes on all claims that legitimately span multiple months
- Document all services clearly with treatment duration and medical necessity for extended services
- Validate claims before submission to ensure date ranges do not inadvertently cross month boundaries
- Stay current with payer-specific guidelines for multi-month service billing
- Use billing system rules to automatically flag claims that span multiple calendar months before submission
Also Filed As
The same CARC 267 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/267
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.