Medical Billing Claims, Explained – Reference

ent. The presenter will go over the difference between the two in this video.

The presenter clarified that a rejection happens prior to adjudication. There are kinds of rejections including a clearing house rejection by your clearing house and also a payer’s refusal, that could have to do with relate to an error that was made on the claim. These are both explained in the video.

Denials, on the other hand, happens at adjudication. That means there’s no technical issues with your claim that could hinder it from passing through the clearinghouse and on to the person who pays. However, a denial will occur if it is determined that the benefits you receive or a policies of your provider do not match what is being claimed in the request.

It’s essential to comprehend the distinction between medical and non-medical billing. It can help you decide whether you should continue the claim even if it has had a failure. If it turns out that the claim was denied, it could be something minor that needs to be fixed and then you can resubmit claims with hopes that it’ll be accepted.


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