OA-267 Denials Explained: How to Identify, Appeal, and Prevent Them

When managing healthcare revenue cycle operations, denials are among the most frustrating and resource-intensive challenges RCM teams face. OA-267 denials, which occur when a claim or service spans multiple months, are especially complex due to the split billing or special handling they require. Understanding these denials, addressing them effectively, and implementing measures to prevent them are critical for maintaining financial health and operational efficiency.

In this post, we’ll break down the OA-267 denial code, compare it to similar codes, explore its causes, and provide actionable steps for appeals and prevention strategies.

What Is a OA-267 Denial?

OA-267 is a denial code indicating that a submitted claim or service spans multiple months and requires additional handling, such as split billing. The prefix OA stands for Other Adjustment, meaning the denial is related to factors beyond patient responsibility (PR) or contractual obligations (CO). In this case, the payer bears financial responsibility for the denial resolution, provided the issue is correctly addressed.

This denial often requires at least one remark code, such as an NCPDP Reject Reason Code or a Remittance Advice Remark Code, to clarify why the claim was denied. Without proper documentation, appeals are unlikely to succeed.

Comparison: OA-267 vs Similar Denial Codes

Denial Code	Prefix Meaning	Reason/Description	Who's Financially Responsible
OA-267	Other Adjustment	Claim/service spans multiple months; requires a remark code	Payer
PR-22	Patient Responsibility	Claim adjusted due to patient payment obligations	Patient
CO-109	Contractual Obligation	Claim denied due to payer policy; contractual agreement with provider	Provider

While OA-267 reflects an administrative issue requiring payer intervention, PR-22 and CO-109 highlight financial responsibilities directly tied to the patient or provider. Understanding these distinctions helps RCM teams target the appropriate resolution pathway.

Common Causes of OA-267 Denials

1. Services Spanning Multiple Months Without Split Billing: Claims that span across different billing periods without proper segmentation often trigger OA-267 denials.
2. Incomplete Documentation: Missing a required remark code or relevant clinical documentation results in claim rejection.
3. Incorrect Payer Submission: Submitting the claim to the wrong payer or failing to account for policy-specific requirements can lead to denial.
4. Errors in Date Range: Misaligned or overlapping service dates within the claim confuse the payer’s processing system, causing denial.
5. System Configuration Issues: Billing software not properly configured for multi-month claims may result in submission errors.

Impact on Revenue Cycle Teams

OA-267 denials can significantly disrupt healthcare revenue cycle operations, creating both financial and operational burdens.

Financial Impact:
- Loss of revenue from denied claims that require extensive rework.
- Increased accounts receivable days, leading to cash flow delays.
- Risk of write-offs if appeals are missed or unsuccessful.
- Higher operational costs due to denial management efforts.

Operational Impact:
- Diverted staff time from other critical RCM tasks.
- Need for payer-specific expertise to resolve complex denials.
- Collaboration challenges among billing, coding, and clinical teams.
- Increased tracking and reporting workload to identify denial trends.

To address these impacts, healthcare organizations must leverage robust denial management solutions like CombineHealth.ai’s Adam (AI Denial Manager). Adam automates the identification, tracking, and resolution of OA-267 denials, reducing manual intervention and mitigating revenue leakage.

Steps To Appeal a OA-267 Denial

Step 1: Review the Denial Notice
Carefully evaluate the denial notice, including the remark codes provided, to understand the reason behind the rejection.

Step 2: Gather Documentation
Compile essential documents, such as clinical records, claim details, and payer-specific requirements, to build a solid case.

Step 3: Verify Eligibility
Confirm that the patient and service are eligible under the payer’s policy to rule out discrepancies.

Step 4: Prepare Appeal Letter
Draft a detailed appeal letter that addresses the denial reason, includes supporting documentation, and outlines why the claim should be reimbursed.

Step 5: Submit Within Deadline
Ensure the appeal is submitted within the payer’s specified timeline to avoid forfeiting reimbursement opportunities.

Step 6: Track and Follow Up
Monitor the status of the appeal and follow up with the payer to address any additional issues or delays.

How To Prevent OA-267 Denials

Front-End Prevention

• Verify Eligibility Early: Conduct eligibility checks before submitting claims to ensure compliance with payer policies.
• Accurate Scheduling: Align service dates with billing periods to avoid multi-month claim issues.

Billing Best Practices

• Split Billing for Multi-Month Services: Segment claims to match billing cycles when services span multiple months.
• Include All Required Codes: Ensure remark codes and documentation are complete at submission.

Technology Solutions

• Automated Claim Scrubbing: Use CombineHealth.ai’s Adam to identify errors in multi-month claims before submission.
• AI-Driven Appeals Management: Leverage Rachel (AI Appeals Manager) to streamline the appeals process for faster resolution.

CombineHealth.ai’s intelligent solutions provide end-to-end support for denial prevention and appeals. With automated tools for eligibility verification, claim scrubbing, and appeals management, RCM teams can significantly reduce OA-267 denials and optimize cash flow.

FAQs

Q1: What does OA-267 mean in medical billing?
OA-267 indicates a denial due to a claim or service spanning multiple months, requiring split billing or special handling.

Q2: Can OA-267 denials be appealed?
Yes, OA-267 denials can be appealed if proper documentation and remark codes are provided.

Q3: How long do I have to appeal?
Appeal deadlines vary by payer but typically range from 30 to 90 days after the denial notice.

Q4: How can I prevent these denials?
Implement front-end verification, split billing practices, and CombineHealth.ai’s automated denial prevention tools. See our complete guide on denial prevention.