210Denial Code (CARC)Active
CO 210 Denial Code: Pre-certification Not Timely
Code 210 indicates that the payer adjusted the payment because the necessary pre-certification or authorization was not obtained in time. This results in a denial since the authorization process was not followed as required by the payer's guidelines.
Who Pays: Group Code Liability
If the payer specifies a CO group code, the provider must write off the amount, and the patient cannot be billed. If the payer uses a PR group code, the patient may be billed for the denied amount. Verify with the payer's policy to determine the correct group code.
Why Claims Get Code 210
- The authorization request was submitted after the service was provided.
- The authorization was not requested at all for a service that requires it.
- The authorization was requested but not received before the timeframe set by the payer.
- The authorization number was not included on the claim form.
- The services provided differed from what was authorized.
How to Fix & Resubmit
- Check the patient's insurance plan to confirm if pre-certification was required for the service.
- Verify the authorization number and the dates of the authorization against the claim dates.
- Contact the payer to understand their specific authorization requirements and timeframes.
- If the authorization was obtained but not submitted, resubmit the claim with the correct authorization number.
- If no authorization exists, contact the payer to discuss possible retroactive authorization or appeal options.
Corrected Claim or Appeal?
Submit a corrected claim if the authorization number was simply omitted. If the authorization was not obtained timely, an appeal may be necessary, particularly if there are extenuating circumstances.
Preventing Future 210 Denials
- Implement a pre-service checklist to verify authorization requirements for all scheduled procedures.
- Train staff to secure authorizations within the payer's required timeframe before services are provided.
- Ensure the billing team cross-checks authorization numbers against claims before submission.
- Establish a robust tracking system for authorization requests and approvals.