Question

A rejected claim is?

a.A claim that has passed through the payer's initial claim processing and was determined not to be a covered service based on coverage criteria.
b.A claim that does not contain the necessary information for adjudication.
c.Both A & B.
d.None of the above.

Answer 1

A rejected claim is both a claim that was not determined to be a covered service by the payer and a claim lacking necessary information for adjudication.

Step-by-step explanation:

A rejected claim refers to a claim that either:

1. Has passed through the payer's initial claim processing and was determined not to be a covered service based on coverage criteria, or
2. Does not contain the necessary information for adjudication.

Therefore, the correct answer to your question is c.Both A & B. When a claim is rejected, it hasn't been processed due to the errors or because it violates the payer's coverage rules. It is often returned to the provider to be corrected or completed before it can be processed and is different from a denied claim, which is one that has been processed but the payment is refused.