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Denial Code 197

CARC 197: preauth/notification absent

This is a Claim Adjustment Reason Code (CARC). CARCs explain why a payer adjusted or denied a claim line and appear with a group code (CO, PR, OA, PI). Codes appear on the EOB / ERA after a claim is adjudicated.

Reference only — CARC/RARC are national code sets updated periodically. Verify against the current official list before acting on a denial or appeal.

Related CARC codes

193
Original payment decision is being maintained. Upon review, it was determined that this cl…
194
Anesthesia performed by the operating physician, the assistant surgeon or the attending ph…
195
Refund issued to an erroneous priority payer for this claim/service
198
preauth/notification exceeded
199
Revenue code and Procedure code do not match
200
Expenses incurred during lapse in coverage

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