Claim rejection rate calculator
Calculate your claim rejection rate from the number of claims you submitted and the number returned by an edit before adjudication.
Updated
Enter your own claim figures to calculate your rejection rate — the share of claims returned by an edit before a payer ever adjudicated them.
Claims returned by an edit at the clearinghouse or the payer's front door. A claim the payer processed and refused is a denial, not a rejection.
All claims submitted over the same period, whatever happened to them afterward.
Enter your figures to see the result and a breakdown.
How it’s calculated
Claims rejected before adjudication ÷ Claims submitted × 100
Count rejections at every gate you submit through — clearinghouse and payer front door — or the rate measures one filter rather than the process. Both figures must cover the same period and the same submission population.
What this assumes
- Count rejections at every gate you submit through. If you count clearinghouse rejections but not the payer's front-door rejections, the result measures one filter rather than your submission process.
- A rejection is not a denial. If denials are included here, the figure is not a rejection rate and cannot be read beside your denial rate.
- One claim rejected twice is a judgment call this calculator does not make for you: count events or count claims, but apply one rule consistently or the trend is not comparable.
- The result is the arithmetic on the numbers you entered. It is not compared to a benchmark — what counts as a rejection depends on which gates you count and how your clearinghouse reports them.
How to read the result
A lower rejection rate generally means claims are leaving in a transmittable state, so fewer round trips are spent before the payer has even looked. Read it as a trend rather than against a fixed target: what counts as a rejection depends on which gates you count and how your clearinghouse reports them, so the figure is comparable to your own history and not reliably to anyone else's. Treat any published average as directional, not absolute.
Read the full claim rejection rate definition