Insurances will deny the claim as Denial Code CO 119 – Benefit maximum for this time period or occurrence has been reached or exhausted, whenever the maximum amount or maximum number of visits or units for the time dated under the plans policy is reached.
To understand the denial code 119 consider the following example:
Assume as per the John plan policy End Stage Related Services are allowed only once per month.
Let us assume John has taken ESRD related health care services on 12/02/2019 and received a payment for the claim from insurance. Again on the same month John received ESRD related health care services i.e. on 12/24/2019.
In this case, Do insurance company pay the date of service 12/24/2019?
Answer: No, insurance will deny the claim with Denial Code CO 119 – Benefit maximum for this time period or occurrence has been reached or exhausted. Because this End stage related healthcare service is allowed only once per month as per the patient policy and John has already received payment for the similar End stage related service on 12/02/2019, so insurance company will deny the claim as per the his plan policy.
Maximum Benefit exhausted in medical billing refers to the maximum amount of money/maximum number of visits/maximum number of units met as per the patient plan policy (specific time period).
If above information not available,
If Benefit Maximum for this time period or occurrence has reached, then ask the following questions:
If Maximum frequency (Units) reached, then check with the following questions:
If Maximum visits reached, then with the following questions:
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