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CARC
CO-197
CARC
CO — Contractual Obligation
Authorization
Quick Facts
Code
CO-197
Type
CARC
Category
Authorization
Status
Active
Precertification/authorization/notification absent
What Does This Code Mean?
The service required prior authorization, precertification, or notification that was not obtained or not on file.
Common Causes
- Authorization never requested before the service was rendered
- Authorization obtained but for the wrong CPT code or date range
- Authorization number omitted from the claim
- Authorization expired before the service date
Recommended Next Steps
- Check payer portal for an existing authorization on file
- If one exists but wasn't submitted, resubmit the claim with the auth number
- If none exists, file a retroactive/late authorization request if the payer allows it
- Appeal citing extenuating circumstances if retro-auth is denied
- Build a pre-service auth verification step into scheduling to prevent recurrence
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Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.