How do I resolve a CO-62 denial?

Verify authorization status in practice management system and payer portal: Determine if authorization was obtained, if it covers the date(s) of service, and whether the services billed exceeded the authorized units or scope Obtain retroactive authorization if claim was filed within contractual timely filing limits: Contact payer authorization department to request backdated authorization if clinical documentation supports medical necessity and contract allows retroactive requests File formal appeal with authorization documentation or contract language: Submit appeal with copies of authorization approval, referral documentation, or contract provisions showing authorization was not required for the specific service or circumstance

835 Denial Combination

CO-62

Contractual Obligation · Claim-Level Adjustment

Contractual Obligation

What This Combination Means

This adjustment indicates the claim was denied or reduced because required pre-certification or authorization was either missing or the services exceeded the authorized amount. The CO group code means the provider is contractually obligated to accept this adjustment as part of their payer agreement and must write off the denied amount rather than balance billing the patient.

Financial Responsibility

provider writeoff

The provider must write off the denied or reduced amount as a contractual adjustment. The patient cannot be billed for this amount under the terms of the provider's contract with the payer.

45%

Appeal Success

30-60 days (appeal process)

Avg. Resolution

Hard

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-62 combination — not generic advice.

Appealable:Appeals depend on whether the provider believes the service should have been covered. Contractual write-offs are generally non-appealable, but if the payer applied the wrong contract terms or the denial was in error, a corrected claim or appeal may be warranted.

1
Verify authorization status in practice management system and payer portal
Determine if authorization was obtained, if it covers the date(s) of service, and whether the services billed exceeded the authorized units or scope
2
Obtain retroactive authorization if claim was filed within contractual timely filing limits
Contact payer authorization department to request backdated authorization if clinical documentation supports medical necessity and contract allows retroactive requests
3
File formal appeal with authorization documentation or contract language
Submit appeal with copies of authorization approval, referral documentation, or contract provisions showing authorization was not required for the specific service or circumstance

Specialty Context

How CO-62 typically presents across different practice types.

Dental

Common for specialty procedures requiring pre-authorization such as orthodontics, implants, oral surgery, or periodontal treatments where authorization was not obtained or treatment exceeded approved phases.

Medical

Frequent for procedures, surgeries, durable medical equipment, imaging studies, and specialist referrals that require prior authorization but were performed without approval or exceeded authorized units.

Behavioral Health

Applies to therapy sessions, intensive outpatient programs, or inpatient admissions that exceed authorized visit limits or were provided without required pre-certification for continued treatment.

Individual Code References

View the standalone definition for each code in this combination.

CARC 62

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Synthesized from official definitions — not from training data

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