What does CARC 198 mean?

CARC 198 means "Precertification/notification/authorization/pre-treatment exceeded.". The recommended action is: Request extension or retroactive authorization; appeal with clinical documentation.

How do I resolve CARC 198?

Pull the original authorization request and approval (if any) Determine whether a retroactive authorization request is an option with this payer Prepare clinical documentation supporting medical necessity for the service Submit the retroactive authorization request through the payer portal Submit a formal appeal once the authorization is obtained or denied Document all communication with the payer in the patient account

Can CARC 198 be appealed?

CARC 198 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

198

🔴 Hard Denial

Precertification/notification/authorization/pre-treatment exceeded.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Common

Frequency

Recommended Action

Request extension or retroactive authorization; appeal with clinical documentation

Step-by-Step Resolution

1
Pull the original authorization request and approval (if any)
2
Determine whether a retroactive authorization request is an option with this payer
3
Prepare clinical documentation supporting medical necessity for the service
4
Submit the retroactive authorization request through the payer portal
5
Submit a formal appeal once the authorization is obtained or denied
6
Document all communication with the payer in the patient account