CO-197 denial: Authorization missing
The payer denied the claim because a required prior authorization or notification was not obtained.
Common causes
- Authorization was not requested before the service
- The authorization was requested but the number did not reach the claim
- The authorization had expired or did not cover the service billed
How to fix it
- Check whether an authorization exists and matches the service and dates
- If it exists, correct the claim with the number and resubmit
- If not, ask the payer whether a retroactive authorization or an appeal is allowed
How to prevent it
- Keep a list of services that need authorization by payer
- Block scheduling for those services until the authorization is on file
Zenith billers and AR specialists work denials like this inside your practice-management system, and your practice stays the billing provider. See AR follow-up and medical billing.
Educational summary, not billing or legal advice. Payer rules and deadlines vary; always check the payer’s own policy and the remark code on your remittance.