GetMax

Claim adjustment reason code · Contractual obligation

CO-197
Precertification, authorization or notification absent

What CO-197 means

The service required prior authorization (or notification) and none was on file.

The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.

Common causes

  • No authorization requested
  • Authorization obtained but not linked to the claim

How to fix it

  1. If an authorization exists, add the number and resubmit
  2. Ask about retro-authorization
  3. Check authorization requirements when the service is scheduled

Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.

Prevent it next time

Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.

Other codes

All denial codes →

Let us work your denials.

We triage every denial by code and payer, fix or appeal it, and stop it repeating.

Talk to us →Denial management service →