What is Clean claim rate?
The share of claims that adjudicate successfully on first submission with no edits, rejections, or rework.
Definition
A clean claim passes clearinghouse edits and payer adjudication without human intervention. Clean claim rate measures how many of yours do. It is the leading indicator for both days in AR and cost to collect, because every non-clean claim consumes staff time before it produces a dollar.
The metric is only as honest as its definition. Counting a claim as clean because it was eventually paid, rather than because it needed no rework, produces a flattering number that tracks nothing useful.
Why it matters
Reworking a claim costs real staff time. Moving clean claim rate up a few points reduces cost to collect and shortens AR at the same time.
Denial codes to know
Related terms
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