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Denial Code CARC 119: Benefit maximum for this time period or occurrence has been reached

CARC 119 means: benefit maximum for this time period or occurrence has been reached. Here's what it means in plain English, why it happens, and how it's worked toward payment.

Why you get a CARC 119 denial

• The patient hit a visit, dollar, or occurrence cap under the plan.
• The payer's accumulator is wrong (the max wasn't actually reached).
• Another plan may have remaining benefits.

How to fix or appeal CARC 119

1. Verify the benefit accumulator with the payer.
2. If the max wasn't truly reached, submit corrected benefit information and rebill.
3. If reached, check for secondary coverage or follow patient-responsibility protocol.

Recoverable when the payer's benefit count is wrong or other coverage exists; otherwise patient responsibility.

CARC 119 — FAQ

Can a benefit-maximum denial be overturned?

Sometimes — payer accumulators are occasionally wrong. Verify the count; if the maximum wasn't actually reached, correct and rebill.

What if the benefit max really is reached?

Check for secondary coverage; if none, it follows the patient-responsibility process with proper notice.