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Rejection vs. Denial

For All Medicare Submitters

To ensure callers reach the department best able to assist with their issue, EDISS would like to clarify the terms Rejection and Denial.

REJECTION means the claim file stopped processing before it reached Medicare. This results in an error on one of the three acknowledgement reports generated by our front-end system – the TA1, 999, and 277CA reports. A remittance advice will NOT be generated. EDISS can assist with Rejection related questions.

DENIAL means the claim processed through EDI, was received by Medicare for processing, but was either not paid or not paid in full by Medicare. This information is communicated to the provider on a remittance advice. The Provider Contact Center can assist with Denial related questions.

Message Sent:
December 7, 2021
June 2, 2020