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CARC 197Authorization absentPrecertification or notification missing

CARC 197: Prior Authorization Missing

This denial family indicates that required authorization, precertification, or notification was not obtained or did not match the claim facts.

First checks

  1. 1Confirm whether authorization was actually required for this plan and date.
  2. 2Compare approval number, code, provider, setting, units, and date range.
  3. 3Read the payer's RARC and denial notice for mismatch detail.

Resolution path

  1. 01Correct a claim that omitted a valid matching authorization number.
  2. 02Request retroactive review only when payer rules permit and facts support it.
  3. 03Appeal a disputed requirement or matching error with the decision trail.
  4. 04Fix scheduling and change-control workflow upstream.

Evidence packet

  • Authorization request and decision
  • Clinical submission
  • Portal or call reference
  • Proof that claim facts match approval

Prevent the next denial

Match authorization to the exact plan, provider, location, service, units, and service dates, then reconcile changes before the service is furnished.

Official sources

CMS Health Care Payment and Remittance AdviceReviewed 2026-07-10Original Medicare Fee-for-Service AppealsReviewed 2026-07-10

Related denial guides

Prior Authorization Missing or Does Not Match

Use the current payer notice, contract, code set, policy, and filing instructions. This guide is educational and does not determine patient liability or appeal rights for an individual claim.