Claim Rejection

Claim rejection occurs when an insurance company refuses to process a healthcare claim due to errors or issues identified during the submission process. Unlike claim denials, which happen after a claim has been processed, rejections typically occur before the claim is even considered for payment. Common reasons for claim rejection include incorrect patient information, missing or invalid diagnosis or procedure codes, incomplete documentation, or eligibility issues.

Claim rejections must be corrected and resubmitted by the healthcare provider, often leading to delays in payment. By thoroughly verifying patient information, ensuring proper coding, and following submission guidelines, healthcare organizations can reduce the likelihood of rejections and improve their revenue cycle efficiency. Addressing claim rejections quickly and accurately helps ensure timely reimbursement and minimizes financial disruptions for healthcare providers.