Precertification/authorization/notification/pre-treatment absent.
Group code
CO, PI or PR
Category
Prior Authorization
Risk level
Critical
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 197 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N83 | No appeal rights. Adjudicative decision based on the provisions of a demonstration project. |
| N210 | Alert: You may appeal this decision |
| M62 | Missing/incomplete/invalid treatment authorization code |
| N758 | Adjusted based on prior authorization decision |
| MA120 | Missing authorization |
| N130 | Consult plan benefit documents/guidelines for coverage of surgery |
| N41 | Authorization request denied |
See the full resolution workflow for CARC 197
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