CO-197 Denial Code Explained
CO-197 is a medical billing denial code that indicates payment was denied because the authorization number is missing, invalid, or does not match the billed service. This denial commonly occurs when authorization requirements are incomplete or incorrect.
DENIAL CODE
Omar Villafuerte
3/7/20221 min read
CO-197 Denial Code Explained
CO-197 is a medical billing denial code that indicates payment was denied because the authorization number is missing, invalid, or does not match the billed service. This denial commonly occurs when authorization requirements are incomplete or incorrect.
What Does CO-197 Mean?
The CO-197 denial code means the insurance payer could not verify valid authorization for the submitted service or procedure.
This denial is often related to prior authorization documentation issues or payer approval mismatches.
Common Reasons for CO-197
Missing authorization number
Invalid authorization approval
Authorization does not match billed services
Expired authorization approval
Incorrect authorization details
Payer authorization policy issues
How To Fix CO-197
Verify the authorization information and confirm the approved services match the submitted claim. Review payer authorization requirements and update the claim with corrected authorization details before resubmitting.
Supporting documentation may also be required during appeals.
Related Denial Codes
You may also encounter:
Quick Summary
CO-197 indicates the payer could not validate authorization for the submitted service. Most denials are related to prior authorization documentation or approval issues.
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