Denial Code CO-197: Description, Meaning and How to Fix It
A required prior authorization, precertification, or notification was not obtained.
Official description
Precertification/authorization/notification/pre-treatment absent.
Common cause
The service needed prior auth and it was missing, expired, or not attached to the claim.
How to fix it
Locate the authorization number and appeal, or request a retro-authorization if the payer allows. Prevent it by checking auth requirements before the service.
Related denial codes
- CO-45: The amount billed is higher than the payer's contracted (allowed) rate. The difference is a contractual write-off, not a patient balance.
- CO-16: The claim is missing required information or has an error. It is almost always paired with a RARC that names the specific missing field.
- CO-97: This service is bundled into another service that was already paid, so it is not paid separately.
- CO-18: The payer received this exact claim/service already.
- CO-22: Another insurer should be billed first under coordination of benefits.
- CO-29: The claim was submitted after the payer's filing deadline.