CARCContractual Obligation
CARC 119: Benefit maximum for this time period or occurrence has been reached
You've used all the allowed visits, days, or dollar amount for this type of benefit this year.
What this means for your claim
Some benefits have annual limits on quantity (e.g., 20 physical therapy visits per year). Once those are used, additional claims are denied.
What to do next
- 1
Ask your insurer for your current benefit utilization count to verify the limit has truly been reached.
- 2
If some visits were applied incorrectly (e.g., a visit you didn't receive), file a correction request.
- 3
For ongoing medically necessary care beyond the limit, ask your physician to file a medical necessity exception request.
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