ANSWERS · REVENUE CYCLE

What is a clean claim rate and how do I improve it?

Clean claim rate is the percentage of claims accepted on first submission without edits or rejections — a healthy target is above 95%. You improve it by fixing front-end data, scrubbing for payer edits before submission, and clearing clearinghouse rejections same-day.

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What actually matters

  • Target above 95% first-pass clean claims
  • Verify eligibility and demographics before the claim goes out
  • Scrub for the payer edits that reject claims — missing modifiers, invalid diagnoses
  • Fix clearinghouse rejections same-day, before they age
  • Measure it — a low clean-claim rate is upstream of your denial rate

Common questions

What's the difference between clean claim rate and first-pass resolution rate?

Clean claim rate is about acceptance without edits; first-pass resolution is about getting paid on the first try. Both should sit above roughly 90–95%.

Where Volari fits: A high clean-claim rate prevents denials; Volari recovers the ones that get through anyway and were written off.

Related answers
How do I lower my practice's denial rate? →How do I reduce days in A/R? →How do I read an EOB or 835 remittance? →How do I know if I'm being underpaid by insurers? →In-house billing vs. outsourcing: which is right for my practice? →How do I renegotiate payer contracts for better rates? →

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