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N719 Remark Code: Plan Requirement Penalty Applied

N719 means the payer reduced payment by applying a penalty because a plan requirement was not met, such as notification or precertification. The claim was paid, but less than it otherwise would have been, and the penalty may fall on the provider or the patient.

Code: N719 (RARC N719)
Status: Active In use since March 1, 2014.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): The penalty is the provider's responsibility, typically because the contract made the provider responsible for meeting the requirement.
PR (Patient Responsibility): The plan assigns the penalty to the member, for example when the member was responsible for obtaining precertification. Verify before billing.
Official description: Penalty applied based on plan requirements not being met.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N719 means

Many health plans do not deny a service outright when a procedural requirement is missed. Instead, they pay a reduced amount and apply a penalty. N719 is the remark that tells you this happened. The requirement is often precertification or admission notification, but it can be any condition the plan document or provider contract sets.

The group code is the key detail. CO means the penalty is on you, usually because your contract makes the provider responsible for the step. PR means the plan places it on the member, which happens in some plans where the member must precertify.

Common causes

Precertification was requested after the service or admission instead of before it.
An inpatient admission or change in level of care was not reported within the plan’s notification window.
The service was performed outside the plan’s required program or network pathway.
The authorization existed but for a different provider, facility, or date span.

What to do

Read the CARC paired with N719 to see which requirement failed.
Check your records for an authorization, reference number, or notification confirmation for this service.
If you have proof the requirement was met, request reconsideration and attach it.
If the penalty is valid and reported as CO, post it as a write-off. If it is PR, confirm the patient’s plan terms before billing.
Track penalty amounts separately from denials so their cost is visible.

How to prevent it

Tie scheduling and admissions to an authorization check so penalties are caught before service. Payer-by-payer notification rules are covered in authorization and referral denials.

Codes that may appear with N719

CO-95 (Plan procedures not followed.): Plan procedures were not followed, which is the reason the penalty was triggered.
CO-210 (Payment adjusted because pre-certification/authorization not received in a timely fashion): Pre-certification or authorization was not received in a timely fashion.
CO-197 (Precertification/authorization/notification/pre-treatment absent.): Authorization or notification was absent entirely.

N758 (Adjusted based on the prior authorization decision.): Payment adjusted based on a prior authorization decision, rather than a penalty for missing a requirement.
CO-61 (Adjusted for failure to obtain second surgical opinion): A specific penalty for not obtaining a second surgical opinion.
N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents for the restriction that applies.

N719 FAQ

Is N719 a denial?

Usually it is a reduction. The service was covered, but a penalty for an unmet plan requirement reduced the payment. Check the adjustment amount and group code on the line.

Which plan requirements trigger penalties?

Common examples are late or missing precertification, failure to notify the plan of an admission, and not using a required program. The exact rule and penalty amount are set by the plan, so check its documents.

Can I get an N719 penalty reversed?

If the requirement was actually met, for example you have an authorization number or a notification confirmation, submit that proof through reconsideration or appeal. Penalties for genuinely missed steps are harder to reverse.

Can the patient be billed for the penalty?

Only if it is reported under PR and your contract and applicable law allow it. A CO penalty is a provider write-off.

Important: read before using this information

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