7. What is the difference between a denied claim and a rejected claim?

A denied claim refers to a claim that has been processed and the payer has found it to be not payable and must be appealed for reconsideration. A rejected claim refers to a claim that has not been received by the payers due to invalid or missing information provided, (i.e.: name and identification number do not match, invalid procedure and or diagnosis codes.) It can be resubmitted electronically immediately with correct information. Because paper claims do not catch this information, the claims must first reach the payers and be rejected, and then resubmitted with corrected information. This can take up to 3 weeks before it reaches the provider, whereas with electronically submitted claims, errors are caught before the claim reaches the payers.