CO-15 denial code: authorization number missing, invalid or not applicable

Claim adjustment reason code 15 says: the authorization number is missing, invalid, or does not apply to the billed services or provider.

With group code CO, the patient can't be billed. The good news: CO-15 often means an approval exists and the claim just doesn't show it correctly.

CO-197 says no approval was obtained. CO-15 says the number on the claim is the problem. In practice payers use both for missing approvals, so the first step is always to check whether one exists.

• The authorization number wasn't on the claim, though the approval was on file.
• The number was typed wrong or belongs to another patient.
• The approval covers different codes from the ones billed.
• The approval names a different provider or location from the claim.
• The dates don't match: the approval expired or started after the date of service.
• More visits or units were billed than approved.

1. Find the approval and compare it with the claim, field by field: number, codes, units, dates, provider and location.
2. If the claim was wrong, correct it and resubmit with the right number.
3. If the approval was wrong, ask the payer to update it where its rules allow, then resubmit.
4. If no approval exists, treat it as a CO-197.

• Carry the authorization number onto the claim automatically, not by retyping it.
• Check codes, units, dates and provider against the approval before sending.
• Re-check approvals before the visit, so changes are caught while they can be fixed.

CO-15 is about the approval matching the claim, so it is prevented before the visit and at billing.

Claira Health's AI agents make sure approvals and referrals are in place before the patient is seen, and raise a hand before they run out. Your team sees only what needs a decision, and approves every step. On a 20-minute call, we’ll walk through it using one of your own denials.

Book a 20-minute call and bring a CO-15 you've had recently.