What is Rejection?
Also called: claim rejection · front-end rejection
The danger is invisibility. A rejected claim exists in the practice management system as submitted and in the payer's system not at all. If nobody reads the clearinghouse acknowledgement reports, the claim ages silently until timely filing expires.
Rejections are also the cheapest failure to fix, usually a demographic or identifier correction taking minutes — provided somebody looks.
Where Vizora handles this
Primary sources
Where "Rejection" is defined by the bodies that set the rules, rather than by us.
- Claim Adjustment Reason Codes (CARC) (opens in a new tab)
X12 — The authoritative, maintained CARC list. Our denial code lookup explains these in plain English; X12 is where the canonical definitions live.
- Remittance Advice Remark Codes (RARC) (opens in a new tab)
X12 — The remark codes that qualify a CARC on an ERA. Reading the RARC is usually what tells you whether a denial is appealable.
- Medicare claims appeals process (opens in a new tab)
Centers for Medicare & Medicaid Services — The five levels of appeal, what each requires and the deadline for each. Missing a level's deadline ends the appeal regardless of the claim's merits.
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.
Clearinghouse
A clearinghouse is an intermediary that receives claims from providers, validates and reformats them into each payer's required electronic standard, and routes them onward. It also returns acknowledgements, rejections and electronic remittance advice, acting as the single connection point to hundreds of payers.
Timely Filing
Timely filing is the deadline by which a payer must receive a claim. Limits commonly range from 90 days to one year from the date of service, vary by payer and contract, and are shorter for secondary claims. A claim denied for timely filing is generally unappealable and unbillable to the patient.
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.
More in Denials and appeals
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