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Claims Rejected (PI3383)

Number of claims that were submitted to the organization but were rejected during the reporting period.
Reporting format
Unit Referenced within Metric Definition
Metric type
Flow
Metric level
Product/Service, Organization
IRIS metric citation
IRIS, 2016. Claims Rejected (PI3383). v4.0.

Footnote

Organizations should footnote all assumptions used as well as reasons that the claims were rejected. See usage guidance for further information.

Usage Guidance

  • This metric should capture the number of claims that have been disqualified for benefit payment (i.e., rejected) for whatever reason.
  • Examples of reasons for which claims might be rejected, to footnote, include: claims submitted for events that are not covered, claims submitted before the waiting period has lapsed, the insured is no longer covered due to expiration of the coverage period or by attaining maximum eligible age, etc.