Denial Code CO-198: Precertification/Auth Not Obtained
What Does Code 198 Mean?
Precertification/notification/authorization number may be required but was not provided or was invalid.
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?
Claim submitted without the required prior authorization number.
How to Resolve It
- 1Obtain the authorization if not yet done
- 2Resubmit the claim with the correct auth number
- 3If auth was denied, initiate a peer-to-peer review
This Denial Is Often Overturned With a Peer-to-Peer Call
When you receive denial code CO-198, 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.