Denial code

CARC 197 denial code: meaning & whether to appeal

CARC 197: the exact X12 wording, how it is classified, and whether it is worth appealing.

Appealant EditorialX12 verified3 min read

What CARC 197 means

Precertification/authorization/notification/pre-treatment absent.

Verbatim description from the official X12 Claim Adjustment Reason Codes list.

Classification

Denial class: prior authorization

Appealability verdict

Appealable — prior authorization

What to know

Check whether an authorization actually existed (wrong number, wrong provider on the auth, or payer mismatch are common), whether a retro-authorization path exists, and whether the payer met its own decision deadlines.

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