Rejection versus Denial

In general, when an insurance company rejects a claim, they do not keep a record of that claim in their adjudication department. However, when a claim is denied, a record of that claim is kept.

When a claim is rejected (electronic claims only), you will receive an EDI Rejection on your dashboard under Electronic Claim Errors. This typically gives you the opportunity to make changes before resending the claim.

Note: Paper claims do not get rejected as they do not go through a clearinghouse.

Denials (paper or electronic) will come back on an Explanation of Benefits (EOB) or an Electronic Remittance Advice (ERA).

Resending claims

For more information on resending claims, please see: Resubmission versus Corrected Claim.