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[PRACTICE LETTERHEAD] [Date] [Insurance Company Name] [Appeals Department Address] [City, State ZIP] RE: Appeal for Claim Denial, CO-197 Patient Name: [Patient Full Name] Patient ID/Policy Number: [Number] Claim Number: [Claim Number] Date of Service: [DOS] Denied Amount: $[Amount] Denial Code: CO-197 (Precertification/Authorization Absent) Dear Appeals Committee: We are writing to formally appeal the denial of the above-referenced claim under reason code CO-197
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