If you track only one billing number, make it your clean claim rate. It tells you how often claims are paid on first submission without rework, and rework is where billing costs and delays come from.
What is a clean claim rate?
Clean claim rate is the percentage of claims accepted and processed by the payer on first submission, without being rejected, returned for more information or denied. Formula:
Clean claim rate = claims accepted on first submission ÷ total claims submitted × 100
What is a good clean claim rate?
A common industry target is 95% or higher, and well-run billing operations aim for 98%. If yours is below 90%, one in ten claims needs to be touched again, which slows cash flow and costs staff time.
How is it different from denial rate?
Denial rate counts claims the payer adjudicated and refused to pay. Clean claim rate is broader: it also includes clearinghouse rejections and claims returned for missing information before adjudication. Improving it usually lowers your denial rate too.
Four changes that raise it fastest
- Verify eligibility before every visit. Coverage issues are the most common front-end error.
- Scrub every claim. Automated edits catch invalid codes, missing modifiers and demographic mismatches before submission.
- Fix rejections the same day. Clearinghouse rejections are quick to fix while the visit is fresh.
- Feed errors back. Share the top rejection reasons with the front desk and providers monthly.
Our free billing audit measures your current clean claim rate and shows the fixes with the biggest effect.