What a clean-claim rate is
Your clean-claim rate is the percentage of claims accepted and paid on the first submission — no edits, rejections or denials. Every claim that isn't clean has to be reworked, which costs time and delays payment.
Why it matters
A high clean-claim rate means faster cash, less staff rework, fewer write-offs, and a lower cost to collect. A few points of improvement can meaningfully raise net collections.
What's a good rate?
As a general benchmark, 95% or higher is good and 98%+ is excellent. If you're below ~90%, there's real money being lost to preventable rework and denials.
How to improve yours
- Verify eligibility and benefits before the visit
- Capture accurate patient demographics and insurance details
- Code accurately to medical necessity, with the right modifiers
- Scrub claims against payer rules before submission
- Track denial reasons and fix the upstream process, not just the one claim
Synergy's approach
Our claims are coder-reviewed and scrubbed before they go out, and we target a 98% clean-claim rate with claims submitted within 24 hours. We also feed denial patterns back into the front end so the rate keeps improving. Get a free audit and we'll show you your current clean-claim rate.
Frequently asked questions
What is a good clean-claim rate?
As a general benchmark, 95% or higher is good and 98% or above is excellent. Below roughly 90% usually signals preventable denials and lost revenue.
How do I improve my clean-claim rate?
Verify eligibility up front, capture accurate demographics, code to medical necessity with correct modifiers, scrub claims before submission, and track denial reasons to fix root causes.