What's the difference between denied claims vs. rejected claims?
The phrases are similar, but there is a difference between denied health claims and rejected claims.
A denied claim is often a claim with an error or one that violates the health plan’s fine print. For instance, a denied claim may happen if the provider didn’t get the required prior authorization for a treatment or the plan doesn’t cover the service. The insurance payer may reverse the denial if the provider offers the needed paperwork and documentation.
A rejected claim is usually connected to a provider’s office entering incorrect billing codes in the claim. Billing errors are a fairly common reason for rejected claims. A provider can resubmit with the correct information to rectify the issue.