What is Denial Rate?
Also called: claim denial rate · first pass denial rate
Track it three ways or it will mislead you: by payer, because one contract usually dominates the total; by denial reason, because that identifies the fixable process; and by provider, because coding and documentation habits are individual.
A falling denial rate is not automatically good news. It can also mean claims are being written off rather than appealed, or held rather than submitted.
Where Vizora handles this
Primary sources
Where "Denial Rate" is defined by the bodies that set the rules, rather than by us.
- Revenue Cycle Denials Index (opens in a new tab)
Optum — Denial rates and denial causes derived from roughly 124 million hospital claim remits. Source of the avoidability and front-end origination figures used across this site.
- MGMA DataDive and MGMA Stat (opens in a new tab)
Medical Group Management Association — The practice-level operations benchmarks — days in AR, denial rate, cost to collect — that physician groups are actually measured against.
- Claims denials and appeals research (opens in a new tab)
KFF — Independent analysis of in-network denial rates and how rarely denials are appealed on the marketplace side. Useful counterweight to vendor-published statistics.
Last reviewed August 20, 2026
Related terms
Denial
A denial is a claim the payer adjudicated and refused to pay. It differs from a rejection, which never entered adjudication. That distinction determines your remedy: a rejected claim is corrected and resubmitted, while a denied claim must be appealed within the payer's deadline.
Clean Claim
A clean claim is a claim that passes payer adjudication and is paid on first submission, without rejection, denial or a request for additional information. Clean claim rate — the percentage of claims meeting that standard — is the most direct measure of whether a billing operation is working.
Net Collection Rate
Net collection rate is payments received divided by the amount you were contractually entitled to collect, after removing contractual adjustments. It answers the question gross collection rate cannot: of the money you actually had a right to, how much did you get?
CARC
A claim adjustment reason code explains why a payer adjusted or denied a payment. Maintained by X12, each CARC carries a group code — CO for contractual obligation, PR for patient responsibility, OA for other adjustment — which determines whether the balance may be billed to the patient.
Find out what your denials are costing you
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