Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-197 | Precertification required
Industry
Healthcare
Canonical
/healthcare/error-codes/co-197/
Last Updated
Feb 25, 2026
Summary
This code indicates that required precertification or authorization was not obtained before the service was provided.
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What This Code Means
CO-197 is used when a payer requires advance approval for a service and no valid authorization is on file. This requirement is determined by plan policy. The absence of precertification affects payment eligibility. It does not automatically reflect on service quality or medical necessity.
Where Users Usually See This Code
- EOB statements
- Remittance advice
- Authorization review notices
Why This Code Appears
- Authorization not obtained in advance
- Authorization expired or invalid
- Incorrect authorization information submitted
What Typically Happens Next
- Payment is denied or reduced
- Review or appeal options may exist
- The claim is closed pending action
What This Code Is Not
- It is not a documentation error
- It is not a duplicate claim
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review authorization policies
- □ Verify approval requirements
- □ Track authorization validity periods
Notes And Edge Cases
Authorization rules vary by payer and service type. Emergency services may follow different requirements.
Related Codes
8 links
- CO-167 CodeNo authorization on file
- N216 CodeMissing authorization
- CO-198 CodePreauthorization missing
- CO-61 CodeProcedure not covered for age
- CO-62 CodeNot covered for place of service
- CO-170 CodePayment adjusted due to referral absence
- CO-200 CodeNon-covered service
- CO-26 CodeExpenses incurred before coverage
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