What Is The Clean Claim Rate?

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What Is The Clean Claim Rate?

Description:

This KPI shows the number of "clean" claims submitted compared to all claims filed with managed care plans.

Why is This KPI Important?

A "dirty" claim is a claim that will have payment delays. More billing systems attempt to catch claims that may be missing important pieces of information before sending to the managed care company for payment. These "dirty" claims should be routed back to the person responsible for the claim not being clean so that they can learn why their actions could have caused a delay in payment. This feedback is a learning process to ensure that your staff and providers seize the opportunity to avoid similar mistakes going forward.

PMI Recommended Frequency to Run this KPI:

Daily

​Formula:

Clean Claims / Total Claims Submitted

Show the Math:

950 / 1,000 = 95%

​How Should I Track It?

This KPI can be tracked using an Excel spreadsheet by Practice and/or Department.

 

 
Picture of Paul Vanchiere, MBA

Paul Vanchiere, MBA

For over 15 years, Paul has dedicated himself exclusively to addressing the financial management, strategic planning, and succession planning needs of pediatric practices. His background includes working for a physician-owned health network and participating in physician practice acquisitions for Texas's largest not-for-profit hospital network, giving him a distinctive insight into the healthcare sector. Paul is adept at conducting comprehensive financial analysis, physician compensation issues, and managed care contract negotiations. He established the Pediatric Management Institute to offer a wide range of services tailored to pediatric practices of all sizes and stages of development, with a focus on financial and operational challenges. Additionally, Paul is actively involved in advocacy efforts to ensure healthcare access and educational opportunities for children with special needs.

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