Rejected vs. Denied Claims
A rejected claim, not as serious as the denied claim, contains mistakes that prohibit the bill from being processed. These claims are returned for rewriting and can then be sent again by the biller. Denied claims are eligible to be processed and then marked as not payable. The reasons are manifold: there could be term violations of the insurance policy, or some other invalid error. What the biller gets back is a reason for the denial, and the chance to resubmit. When bills go through a clearinghouse, they’ll scrub the bills, which helps the chances of claims being accepted on one try. That’s important because every bill that is rejected or denied costs you resources to resubmit.
- Patient vital and residential data
- Provider data
- Insurance provider data
- Bad coding – including the unmatched and incorrect codes
- Incomplete coding
- Double Billing – when the physician’s office makes another claim without verifying if it’s already been done