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Glossary

What Is Claim Denial?

A claim denial happens when an insurer refuses to pay all or part of a submitted healthcare claim, for reasons such as missing information, coding errors, lack of authorization or ineligible coverage.

Denials can often be corrected and resubmitted or appealed, but each one costs staff time and delays payment. The better question is why it was denied: tracking denial reasons shows where registration, coding or submission needs fixing.

Practices usually watch their denial rate and the top denial reasons by payer, and feed the lessons back into earlier steps of the revenue cycle.

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