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N819 Remark Code: Patient Not Enrolled in EVV System

N819 means the patient is not enrolled or set up in the Electronic Visit Verification (EVV) system the payer uses, so there are no verified visits to match to the claim. It appears mostly on Medicaid home care claims.

Quick facts

Code
N819 (RARC N819)
Status
Active In use since July 1, 2019.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service was denied because of a setup issue on the provider or program side. It is not billed to the member.
Official description
Patient not enrolled in Electronic Visit Verification System.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N819 means

Before EVV can verify a visit, the member has to exist in the EVV system and be linked to the provider agency delivering the care. N819 means the payer looked for the patient in EVV and couldn’t find them. Without an enrolled member, there are no verified visits to compare against the claim, so the service isn’t paid.

This is a setup problem, not a coverage decision. It usually occurs on Medicaid personal care or home health claims, where states are federally required to use EVV, and it generally appears with CARC 16.

Common causes

  • New member or new authorization that hasn’t been loaded into EVV yet.
  • Member ID mismatch between the EVV record and the claim, such as an old Medicaid ID.
  • Agency not linked to the member after a transfer from another agency.
  • Third-party EVV system where the member was created locally but never synced to the state aggregator.
  • Name or date of birth discrepancies that stop the records from matching.

How to fix it

  1. Check the member’s record in your EVV system and in the state aggregator or plan portal, if you have access.
  2. Compare identifiers. Confirm the Medicaid ID, name, and date of birth match the claim and the eligibility response.
  3. Complete or correct enrollment following your state’s EVV process, which may involve the state, the plan, or your EVV vendor.
  4. Confirm the visits now appear as verified in EVV.
  5. Resubmit the claim as your state requires for corrected or new claims.

How to prevent it

  • Make EVV member setup part of your intake checklist for every new client or authorization.
  • Reconcile the member list in EVV against active authorizations each month.
  • Use a single source for member IDs so EVV, eligibility, and billing agree.

Codes that may appear with N819

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim can't be processed because required EVV data is missing.
  • CO-A1 (Claim/Service denied.): A general denial explained by the remark.
  • N821 (Electronic Visit Verification System visit not found.): The member is set up, but no EVV visit was found for the service.
  • N824 (Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.): EVV data must be submitted through an approved EVV vendor.
  • N890 (Electronic Visit Verification Data Element Requirements were not met.): EVV data element requirements weren't met.

N819 FAQ

Who enrolls the patient in EVV?

It depends on the state's EVV model. In many states the member is loaded from state or plan authorization data, and the provider agency links the member to its caregivers in the EVV system. Your state's EVV guidance explains the steps.

Why would a member not be in the EVV system?

Common reasons include a new authorization that hasn't loaded yet, a different member ID in the EVV system than on the claim, or a change of provider agency.

Can the claim be paid without EVV?

For services where the state requires EVV, generally not. Some states have exceptions or manual processes; check with the Medicaid program or plan.