Medical & Dental Finance Glossary
What is Claim Denial Rate?
Also called: denial rate, first-pass denial rate
Claim denial rate is the share of submitted insurance claims a payer denies, usually measured on first pass. It is a core revenue-cycle metric for medical and dental practices.
Denials force staff rework and delay cash, and a portion never get collected at all, so the denial rate is a direct drag on realized revenue even when charges look healthy. Industry analysis finds a large share of denials are avoidable through front-end eligibility, prior authorization, and coding accuracy.
Benchmarks vary widely by payer mix. Marketplace-plan denial rates published by KFF run into the high teens percent, which is a useful ceiling reference rather than a universal practice rate. Top-performing practices keep first-pass denials low by fixing the front end, not by hiring more billers.
How it is calculated
First-pass denial rate = claims denied on first submission divided by total claims submitted, over a period. Track alongside the avoidable share and the rework cost per denied claim.
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