3811 Ditmars Blvd# 1124, Astoria, NY 11105

Get the Complete Healthcare Practice Aduit Report

Edit Template

CO 197 Denial Code How to Resolve & Prevent Claim Rejections

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

The CO 197 denial code is a common problem in medical billing, often leading to delayed payments and administrative confusion. Let’s break down its causes, solutions, and prevention strategies with real-world examples to help you reclaim lost revenue.

What Does CO 197 Denial Code Mean?

CO 197 (Claim Adjustment Reason Code 197) signals missing, incomplete, or invalid information on a claim. Insurers like Medicare and commercial payers use this code when critical data (e.g., patient ID, policy number, or procedure codes) is incorrect or outdated.

Example: A clinic’s claims were denied because their EHR auto-filled an expired Medicaid ID for 15% of patients.

Top 5 Reasons for CO 197 Denials

Incorrect Patient Demographics: Typos in names, DOB, or addresses.
Out-of-date Insurance Details: Submitting claims with old policy/group numbers.
Coding Errors: Mismatched CPT/ICD-10 codes or missing modifiers (e.g., 25).
Expired Authorization: Using prior authorization codes beyond their validity period.
System Glitches: EHRs auto-populating outdated data into claims.

How to Fix CO 197 Denials: 7 Actionable Solutions

Audit Registration Workflow: Verify patient data at check-in (scan insurance cards).
Real-Time Insurance Checks: Use tools like Availity to confirm active coverage.
Update Coding Protocols: Align CPT codes with ICD-10 diagnoses (e.g., 99213 + R05 for cough).
Leverage Clearinghouses: Tools like Waystar flag errors pre-submission.
Appeal with Documentation: Resubmit claims with corrected forms and proof of eligibility.
Train Staff Quarterly: Focus on common pitfalls (e.g., modifier-59 misuse).
Monitor CO 96 Denials: CO 96 (non-covered charges) often pairs with CO 197—address both.

Case Study: A Florida hospital reduced CO 197 denials by 65% after training front-desk staff to manually input insurance IDs.

Preventing CO 197 Denials Long-Term

Automate Eligibility Checks: Integrate tools like Epic’s Payer path.
Monthly Claim Audits: Identify patterns (e.g., recurring typos in policy numbers).
Patient Education: Ask patients to confirm insurance updates at appointments.

Need Help? Book a free 15-minute denial audit.

Comprehensive Healthcare Management Services

Recent Blogs

All Post
Medical
Uncategorised

M17.11 ICD Code Comprehensive Guide to Right Knee Osteoarthritis

April 22, 2025

CO 197 Denial Code How to Resolve & Prevent Claim Rejections

April 21, 2025

Physical Therapy Billing Units A Guide to Maximizing Reimbursements

April 18, 2025

Contact US

Frequently Asked Questions (FAQs)

What does CO 197 denial code mean?

CO 197 (Claim Adjustment Reason Code 197) means a claim was denied due to missing, incomplete, or invalid information required for processing. This includes errors in:

Patient demographics (e.g., wrong DOB, misspelled name).
Insurance details (e.g., expired policy number).
Coding mismatches (e.g., CPT code not aligning with ICD-10 diagnosis).

Example: A claim for “John Smith” was denied because the EHR auto-filled “Jon Smith” instead.

What is the code c0197?

c0197″ is likely a typo for CO 197. The correct code is CO 197, used by insurers like Medicare and commercial payers to flag claims with data errors. Always check for typos in patient names, policy numbers, or codes to resolve it.

What is the PR code 197?

PR 197 is unrelated to CO 197.

CO 197 = Claim Adjustment Reason Code (insurer’s reason for denial).
PR 197 = Patient Responsibility Code (explains what the patient owes, like copays).
Focus on fixing CO 197 errors first to avoid claim rejections.

How long do I have to fix a CO 197 denial?

Most insurers allow 90–120 days for appeals. Check your remittance advice.

Does CO 197 affect reimbursement?

Yes—unresolved denials delay payments. Fix errors quickly to avoid write-offs

How is CO 197 different from CO 96?

CO 96 = non-enclosed service; CO 197 = data errors. Fix CO 197 first to avoid CO 96 cascades.

States We Serve

Discover Cures Medical Billing Services Across Different States

Florida

New York

Maryland

Colorado

New Jersey

Arizona

Texas

California

Hawaii

Georgia

North Carolina

Washington

Your Success Is Our Success

We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

At Cures Billing Services, we prioritize collaboration and recognize the uniqueness of each healthcare provider or organization
Maximize your revenue by focusing on growing your practice and let us handle all the back-end billing processes.
We can customize reports to support your practice’s unique requirements

Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.