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Healthcare Management vocabulary · Billing and Coding

Claim denial

Meaning in healthcare management, with examples

nounCommon term

In healthcare management, claim denial means: A payer's refusal to pay a claim, for example because approval was missing, the codes were wrong, documents were missing or the service is not covered.

In Turkish: fatura reddi, talep reddi, ödeme reddi

How it is used

Billing teams in the US often just say 'denial': denial rate, denial management, appealing a denial. Managers analyse why claims are denied and fix the causes at the source, because reworking denied claims is slow and costly.

Example sentences

  1. Our claim denial rate fell to 4% after we added a coding check before submission.

  2. Most claim denials last quarter were caused by missing prior authorization.

Common collocations

  • claim denial rate
  • appeal a denial
  • denial management
  • reduce claim denials
  • claimA formal request that a hospital or patient sends to an insurer or public payer, listing the care given and asking to be paid for it.
  • prior authorizationApproval that a provider must get from an insurer before certain tests, treatments or medicines; without it, the insurer may refuse to pay.
  • clinical codingThe process of turning the diagnoses and procedures in a patient's record into standard codes, which are used for payment, statistics and planning.
  • accounts receivableMoney that patients, insurers and other payers owe the hospital for care that has already been provided but not yet paid for.

More terms: Billing and Coding

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This page explains English vocabulary for learners. It is not medical advice.