A clean claim is one with no errors or missing information, which the payer can process without asking for more. The clean claim rate measures how often your claims go out right the first time.
A low clean claim rate means rework, slower payment and more denials. Claim scrubbing before submission is the main way to raise it.
Formula
Clean claim rate = claims accepted without edits or rejections on first submission ÷ total claims submitted × 100
Related terms
- Claim scrubbing
- Checking a claim for errors and payer rules before it is submitted.
- First-pass resolution rate
- The share of claims paid on the first submission, with no rework.
- Denial rate
- The share of submitted claims that payers deny.