A denied claim has been received and processed by the payer, which decided not to pay all or part of it. The reason is given on the remittance as a claim adjustment reason code (CARC), often with a remark code (RARC).
Denials can be corrected and resubmitted, or appealed, depending on whether the claim or the payer's decision was wrong.
Related terms
- Claim rejection
- A claim returned before processing because of errors; it never entered adjudication.
- CARC (claim adjustment reason code)
- The standard code that explains why a claim line was paid differently than billed.
- Claim appeal
- A formal request asking the payer to reconsider a denied claim.