What’s the Difference Between Rejected and Denied Medical Claims?

Rejected and denied medical claims are both reasonably expected in the healthcare process. If you’re considering medical billing as a career, you’ll need to know the difference between the two.

A rejected medical claim and a denied medical claim sound synonymous with each other, right? You would think so! But the two are entirely different claims.

What are Rejected Claims?

A rejected medical claim typically has an error in it and is never processed or seen by the party that pays. The errors prevent insurance companies from paying and are sent back to the medical biller to correct.

Some of the common errors that lead to a rejected claim:

• Mismatched procedures
• Incorrect insurance numbers
• Incorrect ICD codes
• System coding issues

After the biller corrects the errors, the biller can resubmit the claim to the insurance company.

What are Denied Claims?

Denied medical claims are received and processed by an insurance company but deemed unpayable by the payer.

Common Reasons for Denials:

• The insurance company reviewed the claim and made a negative determination.
• The claim is missing information.
• The claim isn’t a necessary medical service.
• It’s for a service that isn’t covered by the insurance company.

Unlike a rejected claim, a medical biller cannot directly resubmit a denied medical claim.

To resubmit a denied claim, a medical biller must:

• Determine why the claim was denied
• Correct the claim if the claim contained an error
• Obtain an appeal or request for reconsideration

Time is of the essence when correcting and resubmitting a denied claim. Insurance companies allow a specified amount of time for resubmission; otherwise, the claim will remain unpaid.

Suppose a denied claim gets resubmitted without the proper appeal or request for reconsideration. In that case, it will get treated as a duplicate claim and denied.

Deal with Rejected or Denied Claims

As a medical biller, you’ll be working closely with these terms. It can be intimidating to start learning everything you need to know for a new career, but we can help! Our excellent medical billing course has everything you need to be a successful medical biller.

Tri Smith, Instructor

Tri Smith is a Managing Partner and Instructor at MedicalBillingCourse.com, where he leads both the strategic direction and instructional delivery of the program. With over six years of experience, he works closely with students and internal teams to ensure the course remains aligned with real-world medical billing practices while continuing to evolve with industry needs.

His work focuses on guiding learners through the full medical billing lifecycle, from foundational processes to more advanced topics such as claim accuracy, payer communication, and compliance. He is directly involved in how the course is structured, how assessments are designed, and how students are supported as they progress from training into practical application.

Under his leadership, MedicalBillingCourse.com launched the 2026 edition of the course, which includes the new Medical Billing and Coding certification track and reflects a more modern, structured approach to training. These updates emphasize clarity, real-world readiness, and scalable learning systems that support both new students and returning graduates.

Tri has helped thousands of students complete their certification and move into roles ranging from remote billing positions to in-office healthcare settings and independent billing businesses. His approach emphasizes practical execution, consistent standards, and the ability to turn training into a real opportunity.