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Denial code CO-197: what it means and what to do
Denial code CO-197 on your Explanation of Benefits: Prior authorization or precertification was not obtained before the service.
Check my letter freeWhat CO-197 means
Prior authorization or precertification was not obtained before the service.
CO means contractual obligation: under its contract, the provider is usually responsible for this amount, so an in-network provider generally should not bill you for it.
What to do
Ask your doctor's office whether they requested authorization. They can often request it after the fact or appeal for you.
If it was emergency care, health plans cannot require prior authorization.
Your deadline
Most plans give you 180 days from the denial notice to file an internal appeal. Original Medicare gives 120 days from the Medicare Summary Notice, and Medicare Advantage plans 65 days from their decision. Check the date printed on your letter.
More on this reason: No prior authorization.
Other denial codes
- CO-50
- CO-198
- CO-15
- CO-16
- CO-18
- CO-97
- CO-4
- CO-11
- CO-29
- CO-96
- CO-204
- CO-119
- CO-167
- CO-55
- CO-242
- CO-22
- CO-109
- CO-27
- CO-26
- CO-31
- CO-45
- PR-1
- PR-2
- PR-3