Denial codes / CO-197

Denial code 197

CO-197: No pre-authorization

Pre-authorization/pre-treatment absent.

What to doAppeal with evidence
Often recoverableYes, when worked

The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.

Why dental offices see it

  • The plan requires approval before this procedure and none was on file.
  • The authorization expired or was for a different code or tooth.

What to do

  1. Ask the insurer about retroactive authorization.
  2. Appeal with records showing why treatment could not wait.
  3. Add a pre-authorization rule for this insurer and procedure.

Stop it next time

Keep a list of procedures each insurer and Medicaid plan requires approval for, and check it at treatment planning.

How many CO-197 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.

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Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.