How do I resolve a CO-197+N285 denial?

Locate the prior authorization number in your PMS, the payer's portal, or the original authorization letter. Confirm the auth number is valid for the specific date of service, procedure code, and rendering provider billed. Add the auth number to the claim in the correct field (Box 23 on paper claims, Loop 2300 REF*G1 on electronic 837P). Resubmit as a corrected claim (frequency 7) with the authorization number populated. Consider auditing your billing workflow to ensure auth numbers are being pulled from patient authorization records into claims automatically.

Can I appeal a CO-197+N285 denial?

Yes. CO-197+N285 denials are typically appealable with a 92% success rate. Resolution difficulty is Easy and typically takes 3-7 days.

835 Denial Combination

CO-197+N285

Contractual Obligation · Claim-Level Adjustment

What This Combination Means

Prior authorization was required, and N285 confirms the authorization number is missing from the claim. The authorization may have been obtained but was not included in the claim submission. This is a correctable administrative error — if the auth number is available, simply add it and resubmit.

92%

Appeal Success

3-7 days

Avg. Resolution

Easy

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-197+N285 combination — not generic advice.

1
Locate the prior authorization number in your PMS, the payer's portal, or the original authorization letter.
2
Confirm the auth number is valid for the specific date of service, procedure code, and rendering provider billed.
3
Add the auth number to the claim in the correct field (Box 23 on paper claims, Loop 2300 REF*G1 on electronic 837P).
4
Resubmit as a corrected claim (frequency 7) with the authorization number populated.
5
Consider auditing your billing workflow to ensure auth numbers are being pulled from patient authorization records into claims automatically.

Specialty Context

How CO-197+N285 typically presents across different practice types.

Dental

Predetermination/auth numbers should be entered in Box 23 (Prior Auth Number) of the ADA claim form. Confirm the number is in your system and was mapped to the correct claim field.

Medical

The prior auth number goes in Loop 2300 REF*G1 on the 837P. Confirm your PMS is populating this field from the auth stored in the patient's authorization record.

Behavioral Health

Auth numbers for behavioral health are often session-specific. Confirm the auth number covers the exact DOS and CPT code billed, and that it's entered in the correct claim field.

Individual Code References

View the standalone definition for each code in this combination.

CARC 197 RARC N285

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