Claim adjustment reason code
Denial code CO-197 meaning
CARC 197, usually seen as CO-197: The payer needed a precertification, authorization or notification that is not on file.
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- Reason code
- CARC 197
- Short name
- Authorization missing
- Plain meaning
- The payer needed a precertification, authorization or notification that is not on file.
- Group codes
- CO-197: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- No prior authorization was requested.
- The authorization number is missing from the claim or does not match.
What to check before resubmitting
- Check the payer's prior authorization list for the code.
- Add the authorization number to the claim, or request a retro authorization if the payer allows it.
Remark codes that often come with it
Related reason codes
Related pages
Questions
What does denial code CO-197 mean?
The payer needed a precertification, authorization or notification that is not on file. This is Rivvi's plain-English summary of CARC 197. X12's exact wording is on x12.org.
How do I fix CO-197?
Check the payer's prior authorization list for the code. Add the authorization number to the claim, or request a retro authorization if the payer allows it.
Can I bill the patient for CO-197?
With group code CO, no. CO means the provider absorbs the amount under its contract or the payer's rules.
Which group codes come with CARC 197?
Most often CO (contractual obligation). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.