Services Denied at the Time Authorization/Pre-Certification Was Requested

What it means

The payer had already denied this service when the provider or office requested prior authorization or pre-certification. In other words, the authorization request itself was turned down before the service was even performed or billed, so the claim is now denied because there was never an approved authorization on file.

Common causes

The pre-certification/authorization request did not meet the payer's medical necessity criteria at the time it was submitted
Required clinical documentation was missing or insufficient when the authorization was requested
The requested service was not a covered benefit under the patient's plan
The authorization request was submitted for the wrong service, code, or provider
Payer policy required a different treatment pathway or step therapy before approving the requested service

How to fix it

Pull the original authorization request and the payer's denial letter or notes to confirm the stated reason for denial
Determine if additional clinical documentation can be submitted to support medical necessity and request reconsideration
Check if the payer has a formal appeal or reconsideration process for denied pre-authorizations, separate from the claim appeal process
Verify the service and patient plan benefits to confirm the service was actually eligible for authorization
If the authorization was denied in error (wrong code, wrong provider, clerical mistake), resubmit a corrected authorization request
Communicate with the ordering provider and patient about the denial status before proceeding with non-covered services

Appeal / resubmit

Review the specific denial reason given at the time of the authorization request, since CARC 39 reflects a pre-service decision rather than a post-service billing error. Gather any additional clinical records, physician notes, or peer-to-peer review opportunities that may address the payer's stated concerns. Many payers allow a formal appeal of a denied authorization separate from a claims appeal, so confirm the correct process and timeline. Include a clear timeline showing when the authorization was requested and denied, along with any new supporting documentation.

Related codes

Frequently asked

Does this mean the claim was denied because of a billing error?

No. CARC 39 indicates the service was denied earlier, at the authorization/pre-certification stage, not because of a coding or billing mistake on the claim itself.

Can this denial be appealed?

Often yes, but the appeal typically needs to address the original authorization denial reason, which may require additional clinical documentation or a formal pre-authorization appeal process with the payer.

Should the service still be billed if authorization was denied?

Check payer and patient agreements first; billing without resolving the authorization denial may result in non-payment unless the denial is successfully overturned.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is informational only and does not constitute billing or legal advice. It does not guarantee any specific outcome, appeal result, or reimbursement.