Denial · CARC 197
AUTHORIZATION · MERIDIAN HEALTH PLAN
Denied
679.00
Withheld
Recoverable
679.00
Realistically collectable
Net of rework
648.00
less 31.00
Appeal window
closed 780d 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 | MERIDIAN HEALTH PLAN |
| Denial date | 5 May 2024 |
| Appeal deadline | 3 Aug 2024 |
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 MERIDIAN HEALTH PLAN. 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 | 679.00 | withheld |