Denial · CARC 197
AUTHORIZATION · CASCADE CARE
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 | CASCADE CARE |
| Denial date | 28 Jul 2024 |
| Appeal deadline | 28 Jul 2025 |
Denial workflow
| Field | Value |
|---|---|
| Current status | new |
| Appeal outcome | not recorded |
| Closure reason | not applicable |
What this denial means, and to whom
CARC 197 recurs across 1,177 denials
CARC 197 appears on 1,177 denials in the ingested corpus — 9.1% of 12,891 — carrying $406,422.80 withheld in total. This volume warrants a management investigation across payers, services, locations and evidence results. The shared CARC does not yet establish a shared cause or a single corrective action. Split these cases by evidence result before choosing an intervention, then compare by payer, specialty, location and period.
From: Count and denied value of every denial sharing CARC 197, across the ingested remittances.
Limits: These are counts within the loaded corpus and its reporting period, not the full book of business. A shared reason code is recurrence, not a shared cause: the cases grouped here may arise from different payers, services and failures, and no department is implicated by the count alone.
Adjustments
| Level | Code | Amount | Counts as |
|---|---|---|---|
| line | PI/197 | 119.05 | withheld |