What might an insurance provider issue in response to a claim rejection?

A Notice of Exclusions is issued by an insurance provider when a claim is rejected. This document serves to inform the healthcare provider and the patient about specific services that are not covered under the policy. It helps clarify the reasons behind the rejection, which can be due to a lack of medical necessity, services not being covered, or other policy-specific restrictions.

In contrast, an Advance Beneficiary Notice is typically provided before services are delivered to inform the patient that a service may not be covered, while a claims reconciliation report is generally an internal document used to track and resolve discrepancies in billing. A Medicare Summary Notice outlines the services that were billed to Medicare and the amounts that Medicare paid, but it is not specifically tied to claim rejections. Each of these documents serves distinct purposes in the medical billing and coding process, but a Notice of Exclusions directly addresses the outcome of a rejected claim.