CARC 197 denial code: meaning & whether to appeal (verified)
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.