adjudicated as refused

The invoice element has passed through the adjudication process but payment is refused due to one or more reasons.

Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late').

If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected.

A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer.

Invoice element cannot be reversed (nullified) as there is nothing to reverse.

Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting).