CARCContractual Obligation
CARC 171: Payment denied for absence of, or exceeded, precertification/authorization
Prior authorization wasn't obtained, or the service went beyond what was authorized.
What this means for your claim
Similar to CARC 5, but specifically for situations where authorization existed but was exceeded (e.g., authorized 3 days, patient stayed 5 days).
What to do next
- 1
If the extended service was medically necessary, ask your provider to appeal for retroactive authorization.
- 2
Include physician documentation explaining why additional days or services were clinically required.
- 3
Ask your insurer to review under their clinical criteria — exceeding authorized amounts is often appealable.
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