CO-210: Pre-Certification/Authorization Not Received Timely
The authorization was not received on time. Appeal with proof of timely submission or emergency documentation.
What Does CO-210 Mean?
With CO (Contractual Obligation), the untimely authorization is the provider's contractual responsibility. Appeal with proof of timely submission or emergency documentation. If the authorization was genuinely late, evaluate whether retrospective authorization is still possible.
CARC 210 is specifically about authorization timing — the authorization request was either submitted too late before the service or the post-service notification was not filed within the required window. Unlike CARC 197 (authorization absent entirely), CARC 210 acknowledges that authorization may have been sought but was not received by the payer within their required deadline.
Different payers have different authorization submission deadlines, and some have very short windows for retroactive or post-service notifications. For emergency services, most payers allow a grace period for post-service notification, but this period is often just 24-72 hours. Missing these deadlines can result in full denial of the claim.
Common Causes
| Cause | Frequency |
|---|---|
| Prior authorization submitted after the required deadline The provider submitted the authorization request after the payer's required timeframe, typically before or within a set number of days after the service | Most Common |
| Retrospective authorization not obtained within allowed window The provider failed to request retrospective authorization within the payer's allowable post-service timeframe | Most Common |
| Emergency service notification not submitted timely An emergency service was provided but the required notification or post-service authorization was not submitted within the payer's required timeframe | Common |
| Authorization request delayed by administrative process Internal delays in the provider's office (staffing issues, workflow gaps) caused the authorization request to be submitted late | Common |
| Payer-specific deadline not known or followed Different payers have different authorization submission deadlines and the provider missed the specific deadline for this payer | Occasional |
How to Resolve
- Gather submission proof Collect fax confirmations, portal timestamps, and call logs showing when the authorization was submitted.
- Appeal if timely Submit proof that the authorization was within the deadline.
- Document emergencies For emergency services, reference the payer's emergency notification policy.
- Request retrospective authorization If still within the allowed window, submit a retrospective request.
Appeal with proof that the authorization was submitted within the required timeframe (fax confirmations, submission receipts, phone call logs). If the service was an emergency, document the emergency circumstances and reference the payer's emergency service authorization policy. Request retrospective authorization if still within the allowed window.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-210:
| RARC | Description |
|---|---|
| N386 | This decision was based on a National Coverage Determination (NCD) or Local Coverage Determination (LCD). Review the NCD/LCD for authorization timeline requirements → |
| N130 | Consult plan benefit documents/guidelines for coverage of this service. Review the plan's specific authorization submission deadline requirements → |
How to Prevent CO-210
- Implement a systematic process to identify and submit prior authorizations before services are scheduled
- Maintain a payer-specific authorization deadline reference for all contracted payers
- Set up automated reminders for authorization submission deadlines in your scheduling system
- Designate dedicated staff responsible for tracking and submitting authorizations
- Implement same-day or next-day notification processes for emergency and urgent services that require post-service authorization
- Track authorization submission dates and confirmations as part of the claim filing process
Also Filed As
The same CARC 210 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
- https://www.aapc.com/resources/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.