119Denial Code (CARC)Active
CO 119 Denial Code: Max Benefit Reached - Fix & Appeal
Code 119 means the patient's plan has reached its benefit limit for the specified service or time period. This code appears when the payer determines that the maximum allowable benefits have been exhausted.
Who Pays: Group Code Liability
For code 119, the group code can be CO or PR. If the service is non-covered due to benefit exhaustion, the patient is typically responsible (PR) and can be billed. If the contract specifies a write-off, it may be CO, in which case the provider cannot bill the patient.
Why Claims Get Code 119
- The patient has reached their annual visit limit for a specific service.
- The patient's insurance plan has a cap on the number of covered treatments per year.
- A specific benefit, like therapy sessions, has been fully utilized.
- The claim was submitted for a service outside the covered time frame.
- The payer's system has not updated after a policy change increasing limits.
How to Fix & Resubmit
- Verify the patient's insurance benefits to confirm the maximum has been reached.
- Check if the service was billed under the correct benefit category or time period.
- Contact the payer to confirm if there have been any errors in benefit tracking.
- If benefits are available, resubmit the claim with corrected benefit information.
- If the patient is liable, bill them according to the plan's terms.
Corrected Claim or Appeal?
Submit a corrected claim if benefits were incorrectly tracked or billed. If the benefit cap is genuine and confirmed, pursue billing the patient if allowed. Appeal if the payer's benefit tracking appears incorrect.
Preventing Future 119 Denials
- Verify benefit limits during patient registration and scheduling.
- Educate staff on tracking patient benefit usage over time.
- Use billing software to flag upcoming benefit maximums.
- Regularly update patient benefit information in your system.