OA-197: Precertification/Authorization/Notification Absent

What Does OA-197 Mean?

With OA (Other Adjustments), the authorization issue was flagged during coordination of benefits. The authorization requirement may apply to one payer in the COB chain. Determine which payer requires the authorization and resolve accordingly.

CARC 197 is one of the most common and costly denial codes in medical billing. It indicates that the service required prior authorization, precertification, or advance notification from the payer, and that requirement was not met before the service was rendered — or the authorization information was not included on the claim.

This denial can occur for several reasons: the authorization was never obtained, the authorization number was not included on the claim form, the authorization expired before the service date, the authorization does not match the billed service, or a retroactive authorization request was denied. The financial impact can be significant because payers may refuse to pay for the entire service when authorization is missing.

How to Resolve

1. Identify which payer requires authorization Review the COB details to determine which payer flagged the missing authorization.
2. Submit authorization documentation Provide the authorization to the payer that requires it.
3. Resubmit through the COB sequence Process the claim through the correct payer order with authorization in place.

How to Prevent OA-197

• Verify authorization requirements for each payer in the coordination chain
• Track authorization requirements separately for primary and secondary payers

Also Filed As

The same CARC 197 may appear with different Group Codes:

Related Denial Codes