What is a claim denial?
A claim denial occurs when an insurance payer refuses payment for a submitted claim — commonly because of a missing authorization, a coding error, an eligibility issue, or incomplete documentation.
A denial is not the same as a rejection: a rejected claim never made it into the payer's system, usually because of a formatting or data error, while a denied claim was processed and refused. Either way, no payment is issued until the problem is corrected.
Common causes in ABA include services delivered outside an active authorization or beyond approved units, an incorrect code or modifier combination, a client whose coverage has lapsed, and session notes that don't support what was billed.
Most denials can be corrected and resubmitted or appealed, but each one costs staff time and delays payment. Practices reduce them by verifying eligibility up front, tracking authorizations, and building claims from documentation that is already complete.