Health Insurance Claim Form

Medical Billing Claim Denial VS. Claim Rejection

What is the difference between denied claims and rejected claims?

Denied claims are claims that were received and processed by the payer and deemed unpayable.

A rejected claim is a claim that contains errors found before the claim was processed.

The medical biller’s goal is to make sure the provider is reimbursed for their services. Unfortunately, errors – both human and electronic – are inevitable. Running a successful and profitable medical practice requires reducing as many of these errors as possible. When an insurance company denies a claim, they keep a record of that claim in their system. If a claim is rejected, however, they don’t keep a copy of the claim in their system.

These errors can be as simple as a transposed digit from the patient’s insurance ID number. A rejected claim can be re-submitted once the errors have been corrected; since it was never entered into their system.

 

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