Claim denial

A claim denial is an insurance plan's formal refusal to pay a submitted claim, and the reasons range enormously in how fixable they are: a missing X-ray or narrative that a plan requires for that procedure code, a coding error, a lapsed credentialing status, or a frequency limitation on one end; a genuine coverage exclusion that no amount of paperwork will change on the other. Treating every denial the same way, either by resubmitting blindly or writing it off automatically, misses money that a specific, correct fix would recover.

The habit that catches recoverable denials is reading the denial reason on the EOB carefully before deciding what to do with it, rather than filing it away with the rest of the day's paperwork. A denial for missing documentation is a same-day fix; a denial from a lapsed credentialing status needs a different kind of correction entirely; a denial from a genuine plan exclusion is the one category actually worth writing off rather than fighting.

A rising denial rate on a specific plan or a specific procedure code is also a useful early signal. It often means something changed on the insurer's side worth investigating before it becomes a pattern.