Clean Claim Rate
Percentage of claims accepted by the payer on first submission without edits or rejections.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 1
- Workspace handoff
- revenue audit →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
Industry target is 95%+. Below 90% suggests upstream issues — eligibility, demographics, coding, modifier, NPI errors.
How it shows up in your practice
Track clean claim rate at the clearinghouse and at the payer. Front-end edits should catch most issues before they leave the practice.
Sources
- CMS — Physician Fee Schedulehttps://www.cms.gov/medicare/payment/fee-schedules/physician
Track clean claim rate in Revenue Audit
Open revenue audit →Related terms
- BillingClearinghouseAn entity that translates electronic transactions between providers and payers and applies front-end edits to reduce rejected claims.
- BillingRevenue Cycle Management (RCM)The end-to-end administrative function tracking patient care episodes from registration through final payment.
- BillingDays in Accounts ReceivableAverage number of days from claim submission to payment, calculated as (total A/R) ÷ (average daily charges).
- Denials & AppealsDenial ManagementThe end-to-end workflow of identifying, categorizing, appealing, and preventing claim denials.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryDays in Accounts ReceivableAverage number of days from claim submission to payment, calculated as (total A/R) ÷ (average daily charges).
- GlossaryRevenue Cycle Management (RCM)The end-to-end administrative function tracking patient care episodes from registration through final payment.
- GlossaryClearinghouseAn entity that translates electronic transactions between providers and payers and applies front-end edits to reduce rejected claims.
- GlossaryDenial ManagementThe end-to-end workflow of identifying, categorizing, appealing, and preventing claim denials.
- GlossaryCardiac Stress Test (93015-93018)CPT codes for cardiac stress testing, with separate codes for the global service, supervision, and interpretation.
- GlossaryCharge CaptureThe process of identifying and recording every billable service furnished during a patient encounter.
- GlossaryConversion FactorThe dollar value multiplied by the geographically-adjusted Relative Value Unit to determine the Medicare-allowable amount for a service.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.