Official CARC description: “Precertification/authorization/notification absent.” Here’s what it actually means, why it fires, and how to get the claim paid.
The service required prior auth and the payer has no record of one. One of the most financially painful denials — and one of the most winnable when there's a story: emergencies, payer misinformation, or auth actually on file under a different number.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Also written: CO-197, CO197, “denial code 197”, “197 denial code” or “reason code 197” — same CARC, different ERA formatting.
Search the payer portal for the auth under every provider NPI and adjacent dates
If found: corrected claim with the auth number in the right field
If emergency: appeal with records showing acuity — auth rules carve out emergencies
If misquoted by the payer: appeal with the call reference number, date and rep name
Appeal with the strongest available theory: (1) auth existed — attach it; (2) emergency exception — attach ER/admission records; (3) payer error — attach call logs. Ask for retro-authorization review, which most plans allow within a window.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
The official CARC description for CO 197 is: “Precertification/authorization/notification absent.” In practice: The service required prior auth and the payer has no record of one. One of the most financially painful denials — and one of the most winnable when there's a story: emergencies, payer misinformation, or auth actually on file under a different number.
Denial code 197 under the CO group (Contractual Obligation) means: Precertification/authorization/notification absent. The number is the reason; the CO prefix decides who is liable — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Yes. CO 197, CO-197, CO197 and “denial code 197” are the same CARC — clearinghouses, payer portals and PM systems just print it differently. Only the group prefix (CO, PR, OA or PI) changes the meaning, because it changes who has to absorb the amount.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Appeal with the strongest available theory: (1) auth existed — attach it; (2) emergency exception — attach ER/admission records; (3) payer error — attach call logs. Ask for retro-authorization review, which most plans allow within a window.