How Do I Appeal an Authorization or Precert Denial?

The Direct Answer

Appeal an authorization or precert denial by submitting your authorization approval letter with the auth number and effective dates, requesting retro authorization if no prior auth was obtained, and documenting that the service met medical necessity criteria. CARC 197 authorization denials represent about 9% of all claim denials. Roughly 35% of authorization appeals succeed when the provider can prove an auth was obtained but not matched to the claim.

How It Works

Check whether prior authorization was obtained for the denied service. If yes, locate the authorization approval letter with the auth number, approved CPT codes, and effective date range. Verify the date of service falls within the auth window and that the auth number was included on the original claim — if it was omitted, correct and resubmit rather than appealing.

If no prior auth was obtained, determine whether retro authorization applies — emergent services, payer processing delays, or services where auth was attempted but not finalized before the encounter. Write your appeal citing CARC 197, attach the auth approval or retro auth request, and include clinical documentation supporting medical necessity. Denial Appeal Pro generates authorization-specific appeal language mapped to your denial details in under 60 seconds.

What You Get

An authorization appeal letter with claim identification, CARC 197 denial reason, authorization proof or retro auth request language, and an attachment checklist covering auth approval letters, clinical notes, and the original claim showing auth number submission.

Authorization denials are often the fastest to overturn when proof exists — the payer already approved the service but failed to match the auth to the claim. Denial Appeal Pro structures the letter so your team focuses on locating auth documentation rather than drafting arguments.

Frequently Asked Questions

What CARC code indicates an authorization denial?

CARC 197 is the primary authorization or precertification denial code. CARC 15 and CARC 39 also relate to authorization issues depending on the payer's remittance configuration.

Can I get retro authorization after a denial?

Many payers allow retro authorization requests when the service was emergent or when prior auth was obtained but not linked to the claim. Submit the retro auth request alongside your appeal with clinical documentation supporting medical necessity.

What if I have an auth number but the claim was still denied?

Attach the authorization approval letter showing the auth number, effective dates, and approved service. Your appeal should demonstrate the auth was valid on the date of service and was either not transmitted on the claim or not matched by the payer system.

How does Denial Appeal Pro handle authorization denials?

Denial Appeal Pro reads CARC 197 and related authorization denials and generates appeals structured around auth proof, retro authorization requests, and medical necessity documentation — in under 60 seconds.