Claims denial rate is the percentage of submitted insurance claims that are rejected or denied by payers on initial submission.

Telehealth claims face unique denial risks: incorrect place-of-service codes, missing documentation of patient location, payer-specific telehealth coverage limitations, and provider credentialing gaps for out-of-state patients. A healthy telehealth denial rate is under 5%; rates above 10% indicate systematic billing process failures requiring immediate attention.

Not all denials are equal. Distinguish between "soft" denials (missing information, easily corrected) and "hard" denials (coverage exclusions, medical necessity rejections). Soft denials indicate process gaps; hard denials indicate eligibility verification or clinical documentation problems.

Track denials by payer and denial reason code. Patterns will emerge—one payer rejecting all audio-only visits, another denying specific CPT codes, a third requiring documentation your templates don't capture. These patterns turn an overwhelming pile of denials into a focused improvement roadmap.

Related terms: Clean claim rate, First-pass resolution rate, Prior authorization success rate