How to Appeal CO-62 Denial: Precertification absent or exceeded
Payment denied or reduced because prior authorization was absent or the authorized amount was exceeded. This guide explains what it means, why it happens, and exactly how to build a winning appeal.
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What Does CO-62 Mean?
Payment denied or reduced because prior authorization was absent or the authorized amount was exceeded.
Commonly seen in:
Step-by-Step Appeal Guide for CO-62
- 1
Locate any authorization number, date requested, or confirmation from the payer
- 2
Gather clinical documentation supporting the medical necessity of the service
- 3
Obtain records of any calls to the payer (dates, reference numbers, rep names)
- 4
Draft the appeal citing state retroactive authorization laws if applicable
- 5
Submit with documentation and follow up within 5 business days
Counter-Arguments to Use in Your Appeal
These are the strongest arguments medical billing professionals use to overturn CO-62 denials.
If auth was obtained, provide the authorization number and approval documentation
For services exceeding auth, provide medical necessity for the additional services
Request retroactive authorization with clinical documentation
Cite state laws requiring coverage when denial of care would be harmful
Regulations and Guidelines to Cite
Citing specific regulations strengthens your appeal and demonstrates you know your rights.
Expert Tip for CO-62 Appeals
Request retroactive auth immediately if services are denied. Provide the clinical urgency that prevented prior authorization.
Frequently Asked Questions
What is a CO-62 denial code?
Payment denied or reduced because prior authorization was absent or the authorized amount was exceeded.
Can I appeal a CO-62 denial?
Yes. All insurance denials are appealable. Authorization denials can often be overturned with retroactive auth requests. Follow the step-by-step guide above and submit your appeal before the payer's deadline, typically 180 days from the denial date.
What documentation do I need to appeal CO-62?
For a CO-62 denial, you typically need: the original denial letter/EOB, clinical documentation supporting the service, any prior authorization records, and a cover letter citing the relevant regulations listed above. The specific documents depend on why the denial was issued.
How long does a CO-62 appeal take?
Most payers are required to process standard appeals within 30–60 days. Expedited appeals (for urgent care) must be decided within 72 hours. Under ERISA, group health plans must provide an appeal decision within 60 days for pre-service and 60 days for post-service claims.
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