Denial · CARC 197
AUTHORIZATION · CASCADE CARE
Denied
204.66
Withheld
Recoverable
204.66
Realistically collectable
Net of rework
173.66
less 31.00
Appeal window
closed 46d 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 | CASCADE CARE |
| Denial date | 7 Aug 2025 |
| Appeal deadline | 7 Aug 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 CASCADE CARE. 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 | 204.66 | withheld |