Which term refers to the official process of denying a claim after it has been submitted?

The term "claim rejection" accurately describes the official process of denying a claim after it has been submitted to an insurance provider. This occurs when the insurer determines that the claim does not meet specific criteria for approval or coverage, often based on policy provisions or other eligibility concerns. When a claim is rejected, it signifies that the insurance company will not pay for the services billed, and this decision is typically communicated in writing to the provider or policyholder.

Understanding this terminology is crucial for navigating the claims process, as it highlights a critical point at which the insured may need to consider further actions such as resubmission, dispute, or appeal depending on the reason for rejection. Other terms like "claim dispute," "claim adjustment," or "claim appeal" represent different aspects of the claims process; for instance, a dispute involves questioning the insurer's decision, an adjustment refers to a modification in the claim amount or terms, and an appeal is a formal request to reconsider a rejected or partially paid claim. Thus, "claim rejection" specifically pertains to the act of outright denying the claim, making it the correct choice.