Prior authorization depends on payer policy

Denial Code CARC 197: Precertification / authorization / notification absent

CARC 197 means: precertification / authorization / notification absent. Here's what it means in plain English, why it happens, and how it's worked toward payment.

CARC 197 — Precertification / authorization / notification absent. Denial family: Prior authorization.

Why you get a CARC 197 denial

The service required prior authorization that wasn't obtained.
The authorization existed but wasn't on file or referenced correctly.
Notification timelines were missed.

How to fix or appeal CARC 197

Confirm whether an auth existed; if so, submit it and request reprocessing.
If none, check the payer's retroactive-authorization policy and file a retro-auth with clinical urgency where allowed.
If retro-auth isn't permitted, fix the pre-service workflow going forward.

Recoverable when an auth existed or the payer allows retro-authorization; otherwise it's a workflow fix.

Have a stack of CARC 197 (or other) denials piling up? Get a free forensic A/R audit →

CARC 197 — FAQ

Can a CARC 197 prior-auth denial be reversed?

Sometimes — if an authorization actually existed (submit it) or the payer permits retroactive authorization with clinical justification. Not every payer allows retro-auth.

How do I prevent CARC 197?

A pre-service eligibility-and-authorization check before the visit is the durable fix — it's the single biggest preventable denial category for many specialties.