CO-197 | Precertification required

Industry

Insurance

Canonical

/insurance/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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Hub

Guides

The Complete Insurance Claim Denial Codes Directory (2026 Edition)

Related Codes

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

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