CARCContractual Obligation
CARC 198: Precertification/authorization exceeded
Authorization was obtained, but the services delivered went beyond what was approved.
What this means for your claim
If your insurer authorized a specific number of visits, days, or units, and the actual care exceeded that amount, the excess can be denied — even though the initial authorization was valid.
What to do next
- 1
Ask your provider to request retroactive authorization for the additional services with clinical justification.
- 2
Have your physician document why the care needed to exceed the original authorization (e.g., complications, slower recovery).
- 3
File an appeal for the excess amount with supporting medical records.
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