Denial Code CO 119 | Description, Reasons, Next Steps & How To Avoid It
Denial code CO 119 refers to a situation when a healthcare claim is denied due to a benefit maximum for the patient’s policy being reached. In other words, the insurance company has determined that the patient has already received the maximum allowed benefits for the specific service, and any additional services will not be covered under their current plan.
The official description of the denial code CO 11 is: “The diagnosis is inconsistent with the procedure.” This means that the submitted diagnosis code(s) does not support the medical necessity of the procedure performed, leading to the denial of the claim.
Common Reasons for the Denial CO 119
- Services provided exceed the policy’s coverage limits or frequency.
- The patient has already utilized the maximum number of allowed visits or services for a specific period.
- Duplicate submissions of the same service or claim.
- Incorrect coding of the services provided, leading to the insurance company believing the maximum benefits have been reached.
Next Steps
- Review the patient’s insurance policy to confirm the maximum allowed benefits and if they have indeed been reached.
- Ensure that the claim was not submitted multiple times or the services were not coded incorrectly.
- If the denial was due