CO-167 | No authorization on file
This code indicates that no valid authorization was found for a service that requires prior approval.
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What This Code Means
CO-167 is used when payer systems cannot locate an authorization record associated with the billed service. Authorization is often required to confirm coverage eligibility before services are rendered. The absence of an authorization affects payment eligibility. This code reflects administrative policy enforcement rather than service quality. It does not indicate an error in service delivery.
Where Users Usually See This Code
- Remittance advice
- EOB statements
- Authorization review notifications
Why This Code Appears
- Authorization was not requested or obtained
- Authorization details were not submitted with the claim
- Authorization was invalid or expired
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What Typically Happens Next
- Payment is denied or reduced
- The claim line is closed per payer rules
- Additional review may be required
What This Code Is Not
- It is not a coding error
- It is not a duplicate claim
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review authorization records
- □ Confirm payer authorization policies
- □ Track authorization validity periods
Notes And Edge Cases
Some payers allow limited retroactive authorization. Authorization requirements differ by plan and service category.
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Related Codes
- CO-197 CodePrecertification required
- N216 CodeMissing authorization
- CO-26 CodeExpenses incurred before coverage
- CO-200 CodeNon-covered service
- CO-22 CodeCare may be covered by another payer
- CO-27 CodeCoverage terminated
- CO-39 CodeServices denied as experimental
- CO-50 CodeNon-covered services