Denial · CARC 197
AUTHORIZATION · MERIDIAN HEALTH PLAN
Classification
| Field | Value |
|---|---|
| Primary CARC | 197 |
| All CARCs | 197 |
| Root cause | AUTHORIZATION |
| Owns the fix | Access Related |
| Appealable | yes |
| Recoverable | yes |
| Recommended action | Precertification/authorization absent. Check whether one was obtained before appealing. |
| Payer | MERIDIAN HEALTH PLAN |
| Denial date | 12 May 2024 |
| Appeal deadline | 10 Aug 2024 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
The modelled appeal window passed 773 days ago
The 835 reports CARC 197 on 12 May 2024, withholding $95.87 from the provider. Modelled recoverable $95.87, less an estimated rework cost of $31.00, leaves $64.87 net. The configured appeal window for this payer ends 10 Aug 2024, 773 days ago. Recommended action: Precertification/authorization absent. Check whether one was obtained before appealing. Confirm the contractual deadline and any exception, reconsideration or correction route with the payer before closing the case.
From: Denial derivation: root cause, appealability, the recoverable amount net of an estimated rework cost, and a filing deadline derived from the denial date.
Limits: The deadline and the recoverable amount are application estimates. The deadline is the denial date plus a configured per-payer window, not a term read from the payer's contract or an appeal notice, and the recoverable figure is a model rather than a promise of payment. Confirm both against the policy before relying on them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/197 | 95.87 | withheld |