CO-197Contractual Adjustment
Precertification or authorization absent
What this code means
Your plan required advance approval for this service and it was not obtained before the service was performed.
What to do next
Ask your provider to file a retroactive authorization request with clinical documentation. Retroactive authorization is sometimes granted, particularly if the service was urgent or if your provider was unable to reach the insurer in time.
Appeal outlook: Moderate for urgent or emergency situations
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