CO-197Contractual ObligationAuthorization
CO-197 Denial Code: Precertification/authorization absent
Precertification, authorization, notification, or pre-treatment requirement was absent.
Why CO-197 happens
- ●Prior auth never obtained before service
- ●Auth obtained for different CPT, provider, or facility
- ●Auth expired before the date of service
How to fix a CO-197 denial
- 1
Check payer portal for any auth on file and match details
- 2
Request retro-authorization if the payer allows it
- 3
Appeal with clinical urgency documentation if retro-auth is denied
How to prevent it
Build an auth-required list by payer/CPT and hard-stop scheduling without auth.
Drowning in CO-197 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.