CO-15Contractual Adjustment
Prior authorization missing or invalid
What this code means
The insurer required pre-approval for this service before it was performed, and that approval was either not obtained or is not showing correctly on the claim.
What to do next
Check whether your provider obtained prior authorization. If they did, ask them to resubmit with the authorization number. If no auth was obtained, file an appeal with clinical documentation supporting medical necessity. Retroactive authorization is sometimes granted.
Appeal outlook: High when clinical documentation is strong
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