Precertification/notification/authorization/pre-treatment exceeded.
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 198 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M62 | Missing/incomplete/invalid treatment authorization code. |
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. |
| N54 | Claim information is inconsistent with pre-certified/authorized services. |
| N351 | Service date outside of the approved treatment plan service dates. |
| N362 | The number of Days or Units of Service exceeds our acceptable maximum. |
| N435 | Exceeds number/frequency approved /allowed within time period without support documentation. |
| N640 | Exceeds number/frequency approved/allowed within time period. |
| N758 | Adjusted based on the prior authorization decision. |
See the full resolution workflow for CARC 198
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every CARC and RARC pairing, plus payer-specific requirements.
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