Stop losing claims to the same denials
RCM Masters is a free community for US medical practices and billing teams. We break down the denials that cost practices the most, and show exactly how to prevent and fix them.
| Service | CPT | Adj. | Paid |
|---|---|---|---|
| Office visit | 99214 | CO-45 | $96.40 |
| ECG, 12-lead | 93000 | CO-45 | $17.12 |
| Echocardiogram | 93306 | CO-197 | $0.00 |
CO-197
Precertification, authorization or notification absent.
What this denial means
The payer expected a prior authorization, precertification or notification for the service, and none was on file when the claim was processed. Because it's a contractual (CO) adjustment, the practice usually can't bill the patient for it.
How to prevent it
- Check authorization requirements when the service is scheduled, not at checkout.
- Record the authorization number where the biller will see it before the claim goes out.
- Recheck when the service changes: a different CPT code or date may need its own authorization.
How to fix it
If an authorization was obtained, correct the claim with the authorization number and resubmit. If it wasn't, ask the payer whether they accept a retro-authorization before deciding to appeal or write it off.
What you'll find at RCM Masters
Denial code breakdowns
What each common denial means, why it happens and what to do next.
Browse on rcmmasters.comShort videos
Quick walk-throughs of denial codes your billing team can watch between claims.
Watch on YouTubePractical guides
Coding, A/R follow-up and front-desk checks that keep claims clean.
Read the guidesWho's behind RCM Masters
RCM Masters is run by Balaji Pandian, CPC-A, who has spent more than 20 years in US healthcare revenue cycle management across Family Medicine, Nephrology, Cardiology, Psychiatry, Gastroenterology and OB/GYN.
The goal is simple: share what actually works in getting claims paid, in plain language, for the people who do the work.
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