First-Pass Resolution Rate

First-pass resolution rate is the share of claims paid on the first submission without any rework — a core efficiency metric where a healthy target is around 90% or better.

First-pass resolution rate (FPRR), sometimes called first-pass acceptance or first-pass paid rate, measures the percentage of claims that get paid the first time you submit them, with no correction, appeal, or resubmission. It's a headline efficiency metric because every claim that doesn't resolve on the first pass costs staff time to rework, and rework is expensive. A healthy target is roughly 90% or higher; consistently below about 85% means too many claims need touching twice. FPRR is closely related to clean-claim rate but not identical: a claim can be 'clean' (pass your scrubber and reach the payer) yet still be denied on the first pass because of a payer edit or policy, so a high clean-claim rate paired with a low first-pass paid rate points the finger at the payer side rather than your front end. For a practice, FPRR is a useful trend line, but it can also hide the real issue: it measures how many claims resolve on the first try, not how much money sits in the ones that didn't. A dip in FPRR is a signal to trace the cause — eligibility, coding, auth, or a specific payer's edits — before it becomes an aging problem.

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