CO-197 denial code: authorization absent

CO-197 means the payer found no precertification, authorization or notification for the service. It is one of the most common denials on residential, PHP and IOP claims.

Typical causes: an admission over a weekend with the auth requested late, a step-down from residential to PHP that went ahead before the new auth was approved, or an auth recorded under the wrong level of care or provider.

Search your auth records before you do anything else. If an auth exists, send a corrected claim with the number. If it does not, ask the payer about a retro review, and check whether emergency or urgent admission rules apply. Many CO-197s are prevented by checking auth status before each claim goes out.