CO-198: Authorization Exceeded
Precertification, notification, authorization, or pre-treatment number of services or period of time exceeded. The services rendered went beyond what was approved in the authorization.
Why Claims Get Denied with CO-198
Denial code CO-198 is triggered when precertification, notification, authorization, or pre-treatment number of services or period of time exceeded. the services rendered went beyond what was approved in the authorization. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
More units or visits provided than the authorization approved
Service rendered after the authorization expiration date
Treatment extended beyond the pre-certified period without renewal
Authorization covered fewer sessions than were actually provided
How to Appeal CO-198
Request a retroactive authorization extension if the payer allows it. Provide clinical documentation justifying the additional services beyond the original authorization. Show that continued treatment was medically necessary and that there was insufficient time to obtain a new authorization.
Documentation Required for Appeal
A successful appeal of CO-198 requires thorough documentation. Gather these items before drafting your appeal letter:
Original authorization showing approved units and dates
Clinical documentation supporting the additional services
Retroactive authorization extension request
Treatment plan showing medical necessity for continued services
How to Prevent CO-198 Denials
Track authorized units and dates for every authorization. Set alerts before authorization limits are reached. Request authorization renewals or extensions before the original authorization expires.
Stop Fighting CO-198 Denials Manually
RediClaim generates payer-specific appeal letters for CO-198 denials in under 60 seconds, complete with the clinical arguments and documentation references that win reversals.