Denial · CARC 197
AUTHORIZATION · NORTHSTAR MUTUAL
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 Apr 2026 |
| Appeal deadline | 23 Oct 2026 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
$538.00 withheld, nothing paid
Billed $538.00. The payer paid $0.00, withheld $538.00. Of the $538.00 withheld, $538.00 is modelled as recoverable; less $31.00 to work it, that is $507.00 net. Precertification/authorization absent. Check whether one was obtained before appealing. To pursue the withheld amount, quote the payer's own claim number from the remittance and the adjudication date 26 Apr 2026, and confirm the route and deadline with the payer.
From: 835 CLP amounts and CAS adjustments on this claim; the denial derivation for the modelled recoverable amount and filing window.
Limits: Patient responsibility reported on an 835 is not revenue. This application cannot say whether the practice billed it, whether the patient paid, or whether a secondary payer covered it — those live in a billing system it does not read. The recoverable figure and the deadline are estimates, not a payer commitment.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/197 | 538.00 | withheld |