What CO-197 means
Precertification, authorization, or notification was required for this service and the payer has no record of it. A leading cause of lost revenue — and frequently recoverable with a retro-auth request or a medical-necessity argument.
Common causes
- Authorization was never obtained before the service
- Auth was obtained but not linked or recorded by the payer
- Emergency/urgent care that bypassed the normal auth window
How to appeal CO-197
If auth exists, submit proof and reference numbers. If it doesn't, request a retroactive authorization and argue medical necessity or an emergency exception with clinical documentation showing the service couldn't wait.
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