CARC 39: Services denied at the time authorization/pre-certification was requested
When your provider asked for prior authorization, the insurer reviewed it and denied the service in advance.
What this means for your claim
Unlike a missing-authorization denial, this means authorization was requested but the insurer declined it — usually on medical necessity or coverage grounds. The denial reasoning should be available and is appealable.
What to do next
- 1
Request the written authorization denial letter, which must state the clinical reason and the criteria used.
- 2
Ask your treating physician to submit additional clinical documentation or request a peer-to-peer review with the insurer's medical director.
- 3
File a formal appeal — pre-service denials often qualify for expedited review if the care is time-sensitive.
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