Standards & EDI
Rejection Reason (Reject Reason Code)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Distinguishing rejections (validation failures, AAA) from denials (adverse clinical determinations, HCR A3) is fundamental to honest metrics. CMS-0057 public reporting concerns determinations; a payer whose intake silently converts fixable rejections into abandoned requests has a provider-experience problem no metric will flatter.