Claims & Denials calculator
Denial Rate Calculator
Your denial rate is the share of claims a payer refuses to pay as submitted. It is the single most watched number in billing because every point of it is revenue delayed, reworked or written off. This calculator needs.
What this calculator shows
Your denial rate is the share of claims a payer refuses to pay as submitted. It is the single most watched number in billing because every point of it is revenue delayed, reworked or written off. This calculator needs two numbers from your clearinghouse or payer reports for the same period.
Count a claim as denied when the payer adjudicates it and refuses payment, for example with a CO denial on the remittance. That is different from a rejection, which happens before adjudication; the claim rejection rate calculator covers that stage.
Claims & Denials calculator
Denial Rate Calculator
Denied claims divided by total claims: your denial rate in one step.
How the calculation works
Denial rate = denied claims / total claims submitted x 100. Example: 90 denied of 1,500 submitted is a 6% denial rate.
How to read your result
What matters next is the mix underneath the rate: authorization denials, eligibility denials, coding denials and timely filing denials each have a different fix. Our guide to reducing claim denials works through the causes, and denial management is the service that works them daily. To see the dollars attached to your rate, use the denial revenue calculator.
Looking for another measure? See all medical billing calculators or the formulas collected in our medical billing KPIs guide.
Before you rely on the number
Results are estimates for educational and operational planning, built from the figures you enter. They are not guarantees of reimbursement, savings or recovery, and they do not replace a review of your own claims, contracts and remittances. Do not enter patient-identifiable or protected health information: this calculator runs in your browser and nothing you type is stored or sent anywhere.
FAQ
Calculator questions
Still have a question? Talk to our team about your billing workflow.
What is a good denial rate?
There is no single official benchmark, and any number quoted without your specialty and payer mix is marketing. What matters is your rate trending down and each denial reason being worked. A rate you measure honestly beats a benchmark you cannot verify.
Should I count rejected claims as denials?
No. Rejections happen at the clearinghouse or payer front door before adjudication; denials are payer decisions after adjudication. Mixing them hides which stage is failing.
Which period should I use?
A month is typical; a quarter smooths out one bad payer week. Use the same period every time so the trend means something.
Want this run on your real claims?
A free billing assessment reviews your actual denials, A/R and contracts, then gives you these numbers from your own data, in writing, before you decide anything.