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How is rejected claims rate calculated and what should I do with it?
Rejected claims rate is the number of claims rejected by the payer divided by the number of claims submitted, multiplied by 100. Use reason codes to find the cause, then correct the process at source, for example in capture, coding or eligibility checks.
It matters because rejections delay payment and, if not resubmitted in time, may be lost.
Commonly misread:
- Treating rejection as the same as denial. Rejected usually means the claim failed before assessment and can be fixed and resubmitted. Check how your payer uses the terms.
- Counting a claim each time it is resubmitted.
- Looking only at the total rate and not the top reasons.
Rank reasons by number and by value, fix the biggest at the point of data entry, and track the resubmission success rate.
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