CARC197ReferenceCurrentVerified Aug 15, 2026CARC 197
AR Guide Workflow
Authorization
The service required prior authorization, precertification, or pre-treatment review that was missing, expired, or did not cover what was billed.
AR Guide explanation
What it means
Precertification, authorization, notification, or pre-treatment review was absent.
AR Guide knowledge
Common denial category
Authorization — The service required prior authorization, precertification, or pre-treatment review that was missing, expired, or did not cover what was billed.
AR Guide knowledge
Common causes
- Prior authorization not obtained
- Required notification not submitted
- Authorization obtained after the service
AR Guide knowledge
What AR should verify
- Confirm the authorization requirement for the service
- Check authorization records for the date of service
- Review the timing of the authorization relative to the service
AR Guide knowledge
Recommended action
- If the service is already rendered, request a retro-authorization or appeal with clinical necessity
- If not yet rendered, obtain authorization before the service
AR Guide knowledge
QA checkpoint
- Verify authorization requirements at scheduling
- Attach the authorization number to the claim
About this guidance: Note
AR Guide knowledge is general reference content written by our team — it is not payer-specific policy and never replaces the payer’s documentation or your contract. Always confirm specifics with the payer.