Claim Denial

When an insurance company refuses to pay a healthcare claim submitted by a provider, often due to errors, lack of authorization, or medical necessity issues.

Technical An insurer's refusal to reimburse a submitted medical claim, based on payer-specific rules such as coding errors, missing documentation, or failure to meet medical necessity criteria.

Example The hospital's billing team appealed the claim denial because the insurer wrongly cited lack of pre-authorization.