CARCContractual Obligation
CARC 197: Precertification/authorization/notification/pre-treatment absent
Required advance approval wasn't obtained before this service was performed.
What this means for your claim
This is a more specific version of CARC 5. The insurer required advance authorization and no record of it exists in their system.
What to do next
- 1
Ask your provider for the authorization number, if one was obtained. Confirm it was submitted on the claim.
- 2
If the service was emergent or urgently required (preventing delay), file an appeal citing medical necessity and urgency.
- 3
If your provider told you authorization wasn't required, ask them to appeal on your behalf.
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