Medical Billing Claims, Explained – Reference Video.net
ent. In this video, the presenter will outline what they are and how they differ in this short video.
The presenter clarified that a rejection occurs before decision-making. There are kinds of rejections including a clearing house rejection from your clearing house, and a payer rejection, one that has to be due to an error made in the claims you submit. These are both explained on the following video.
A denial, on the contrary, occurs at adjudication. That means there’s no technical problems with your claim which could prevent the claim from being processed by the clearinghouse or to the payment provider. Denials are a determination to deny the claim because it is not accepted by your provider or benefits.
It’s vital to comprehend the difference between medical billing and it helps you figure out if you need to continue in submitting a claim that had a failure. If it was rejected, there is likely something small that has to be corrected or corrected before you can submit claims with hopes that the claim will be accepted.