Denial Code CO-197: Precertification/Authorization Not Timely
What Does Code 197 Mean?
Precertification/authorization/notification absent. Required precertification, authorization, or notification was not obtained in a timely manner.
Group Code CO (Contractual Obligation): The provider has agreed to accept the payer's determination. The patient is generally not responsible for this amount.
Why Does This Happen?
The prior auth was not submitted within the required timeframe before the service.
How to Resolve It
- 1Check if a retroactive auth can be obtained
- 2Submit a retro-auth request with clinical justification
- 3If emergency, document the emergent nature of the service
- 4Appeal with documentation of why timely auth was not possible
This Denial Is Often Overturned With a Peer-to-Peer Call
When you receive denial code CO-197, the most effective next step is usually a peer-to-peer (P2P) call with the payer's medical director. During this call, you can present your clinical reasoning directly and often get the denial reversed on the spot.
Our free P2P Call Prep Tool generates a structured script based on your specific case, the payer involved, and the denial reason -- so you walk into the call prepared and confident.