CO-243Contractual ObligationAuthorization
CO-243 Denial Code: Services not authorized by network/primary care providers
Services of this type were not authorized by network/primary care providers.
Why CO-243 happens
- ●Missing PCP referral in a gatekeeper HMO plan
How to fix a CO-243 denial
- 1
Obtain a retro-referral from the PCP if the plan permits
- 2
Appeal with documentation of the referral relationship
How to prevent it
Check referral requirements at scheduling for HMO members.
Drowning in CO-243 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.