Denial · CARC 197
AUTHORIZATION · NORTHSTAR MUTUAL
Denied
6.80
Withheld
Recoverable
6.80
Realistically collectable
Net of rework
-24.20
costs 31.00 to work — more than it returns
Appeal window
closed 151d ago
Closed
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 | NORTHSTAR MUTUAL |
| Denial date | 26 Oct 2025 |
| Appeal deadline | 24 Apr 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
Which team should investigate first?
Route first to Access Related
The remittance carries CARC 197, and the claim was adjudicated by NORTHSTAR MUTUAL. The application maps CARC 197 to Access Related using the originating-area reference. Review the policy selected for the encounter, the coverage effective dates available at registration, and any eligibility response captured before the service.
From: CARC 197 mapped to an owning department through the originating-area reference.
Limits: This is a routing recommendation, not a root-cause finding. The problem could arise from registration data, a later enrolment change, an interface mismatch, or the payer's own adjudication, and this mapping distinguishes none of them.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/197 | 6.80 | withheld |