CO-197: Precertification / prior authorization absent
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
The service required prior authorization and the payer has no record of one. One of the most common — and most fixable — denials.
CO-197 at a glance
- Code group: CO — Contractual Obligation — in-network providers generally cannot bill you for CO adjustments.
- Who usually fixes it: You and the billing office together.
- Worth appealing? Yes — commonly appealed.
What to do about a CO-197 denial
- Ask the provider whether authorization was obtained; a valid number just gets resubmitted.
- If none was obtained, request retroactive authorization — payers grant it more often than people expect, especially for urgent care.
- Appeal if retro-auth is refused; authorization failures by the provider are generally not the patient's bill in-network.
Best next read: Prior authorization denials — the full guide (with a free letter template) for this denial type.
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