CARC243ReferenceCurrentVerified Aug 15, 2026CARC 243
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
Services were not authorized by network or primary care providers.
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
- Required referral/authorization from the PCP not obtained
- Out-of-network referral without authorization
AR Guide knowledge
What AR should verify
- Confirm the authorization/referral requirement
- Check the referral records for the service date
AR Guide knowledge
Recommended action
- Obtain a retro-authorization or appeal with clinical necessity
- Confirm future referrals are authorized before service
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.