How do I resolve a CO-62 denial?

Verify whether the procedure required pre-certification per the patient's plan benefits and the payer's coverage policy. If required but not obtained: contact the payer immediately to request retrospective notification or certification. For emergency admissions: most payers are required to waive notification requirements for true emergencies — appeal citing the emergency circumstances. If the service was elective and no pre-cert was obtained: explore whether the payer's policy allows for a late notification penalty (partial payment) rather than full denial. Implement a pre-certification tracking system to catch all required authorizations before services are rendered.

Can I appeal a CO-62 denial?

Yes. CO-62 denials are typically appealable with a 45% success rate. Resolution difficulty is Hard and typically takes 21-45 days.

835 Denial Combination

CO-62

Contractual Obligation · Claim-Level Adjustment

What This Combination Means

Pre-certification or notification is required for this service. The payer was not notified in advance, or the required pre-certification was not obtained. Similar to CO-197 but specifically relates to pre-certification/notification requirements rather than formal prior authorization.

45%

Appeal Success

21-45 days

Avg. Resolution

Hard

Difficulty

Yes

Appealable

Step-by-Step Resolution

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

1
Verify whether the procedure required pre-certification per the patient's plan benefits and the payer's coverage policy.
2
If required but not obtained: contact the payer immediately to request retrospective notification or certification.
3
For emergency admissions: most payers are required to waive notification requirements for true emergencies — appeal citing the emergency circumstances.
4
If the service was elective and no pre-cert was obtained: explore whether the payer's policy allows for a late notification penalty (partial payment) rather than full denial.
5
Implement a pre-certification tracking system to catch all required authorizations before services are rendered.

Specialty Context

How CO-62 typically presents across different practice types.

Dental

Some dental procedures (complex oral surgery, anesthesia) require pre-certification from the medical plan even when the dental plan covers them. Confirm the notification requirement with both the dental and medical plan.

Medical

Hospital admissions and certain outpatient procedures require pre-certification. Emergency admissions require notification within 24-48 hours in most plans.

Behavioral Health

Inpatient and residential behavioral health admissions require immediate notification (often within 24 hours of admission). Missed notification can result in a denial of the entire stay.

Individual Code References

View the standalone definition for each code in this combination.

CARC 62

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