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Dentovio public answer
On a dental remittance, CARC 197 means: A plan-required pre-service step was not completed, such as approval, certification, notice, or treatment review.
On a dental remittance, CARC 197 means: A plan-required pre-service step was not completed, such as approval, certification, notice, or treatment review. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — depends: check the facts first. Search for evidence the authorization exists before conceding: a reference number, a portal record, a call log. Where authorization genuinely was not obtained, be realistic about back-dating — the one dental programme with a published exception path allows it only in narrow circumstances such as back-dated eligibility, requires the request within 90 days of treatment, guarantees nothing, and states plainly that approvals will not be issued because the provider forgot or did not realise approval was needed. Florida adds a payer-side rule for 2025-renewed contracts: a claim for a procedure specifically included in a prior authorization cannot be denied except in enumerated circumstances.
Dentovio is an independent publisher — not a payer, the ADA, X12, CAQH CORE, or any government agency. Code meanings and remark-code meanings on this page are Dentovio's own wording, written from the official X12 Claim Adjustment Reason Code and Remittance Advice Remark Code lists and linked back to them; X12 holds the copyright in those lists and its descriptions are not reproduced here. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors. Appealability verdicts are Dentovio editorial classification, not a standard. Every fact traces to the code steward's registry, a federal rule or manual, a HIPAA operating rule, an association publication, or a named payer's own document — never to a billing blog. Educational billing reference only — not billing, legal, or clinical advice. Plan contracts control individual outcomes, and processing policies usually live in the payer's provider manual rather than in the signed agreement.
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