What is a clean claim rate?
The clean claim rate is the share of claims accepted on the first submission, without rejections, edits or manual fixes. It measures how well the front end and billing prepare claims.
Clean claim rate, March 2026
| Item | Claims |
|---|---|
| Claims submitted | 5,000 |
| Rejected on the 999 or 277CA | 180 |
| Held or fixed by a person before acceptance | 70 |
| Accepted on the first pass, untouched | 4,750 |
| Clean claim rate: 4,750 / 5,000 | 95.0% |
- Definitions vary. Some organizations count only payer rejections; others count every claim a person touched. Pick one and keep it.
Every claim that isn’t clean costs twice: once to send and again to fix. The clean claim rate shows how many claims made it through on the first try.
How it’s calculated
Clean claims, accepted on first submission without changes, divided by all claims submitted in the period. Organizations define “clean” differently, so comparisons only work with the same definition.
What moves it
Accurate registration and eligibility, complete documentation, and claim scrubbing that fixes problems before sending rather than after rejection. A falling rate usually points to one payer, one location or one kind of error, which the drill-through finds.
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