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Clean Claim Rate & First Pass Resolution Rate Calculator

Enter one month of claims. See how many went through clean the first time, how many were paid on the first pass, and what rework costs you.

Claims submitted (one month)

Claims rejectedBounced by the clearinghouse or payer before they were accepted.

Claims denied on the first passAccepted, then denied in full or in part.

Average claim value ($, optional)

Your cost to rework one claim ($)Use your own number. Many practices estimate $25 or more.

The Formulas

Measure	Formula
Clean claim rate	(Claims submitted minus claims rejected) ÷ claims submitted × 100
First pass resolution rate	(Claims submitted minus rejected minus denied) ÷ claims submitted × 100
First pass denial rate	Claims denied ÷ claims accepted × 100

A clean claim goes through the clearinghouse and payer edits the first time, with no rejection. A claim is resolved on the first pass when it is also paid without a denial or any rework.

A Worked Example

A practice sends 1,000 claims in a month. 40 are rejected and 70 are denied. The clean claim rate is (1,000 minus 40) ÷ 1,000 = 96%. The first pass resolution rate is (1,000 minus 40 minus 70) ÷ 1,000 = 89%. That is 110 claims to rework. At $25 each, rework costs $2,750 a month, or $33,000 a year.

What Good Looks Like

Measure	Common target	Needs attention
Clean claim rate	95% or higher	Below 90%
First pass resolution rate	90% or higher	Below 80%

These are common industry targets, not rules. Track your own numbers every month and watch the trend.

Rejections vs Denials

A rejection means the claim never entered the payer's system, usually because of missing or invalid data. You fix and resend it. A denial means the payer processed the claim and refused to pay all or part. You correct it or appeal. Both cost staff time and delay cash.

How to Raise Your Clean Claim Rate

Verify eligibility before every visit. Coverage errors such as CO-31 are the most common rejections.
Run every claim through a claim scrubber, and fix the edits before sending.
Check NPI, taxonomy and tax ID against each payer's records.
Check units against MUEs with our MUE lookup.
Review the top rejection reasons every week and fix the cause, not just the claim.

Measure the rest of your revenue cycle with the denial rate calculator, net collection rate calculator and days in A/R calculator.

Frequently Asked Questions

How do you calculate the clean claim rate?

Subtract rejected claims from claims submitted, divide by claims submitted, and multiply by 100. For example, 960 clean out of 1,000 claims is a 96% clean claim rate.

What is a good clean claim rate?

Many practices aim for 95% or higher. Below 90% usually means front-end problems with eligibility, data or coding edits.

What is the first pass resolution rate?

It is the share of claims paid on the first submission, with no rejection, denial or rework. Divide those claims by all claims submitted and multiply by 100.

What is the difference between a rejected and a denied claim?

A rejected claim never entered the payer's system, so you fix it and resend it. A denied claim was processed and not paid, so you correct it or appeal.

Hassan Raza Awan, Founder of LegitMedBilling & IT Solutions

Written by Hassan Raza Awan

Founder — LegitMedBilling & IT Solutions

Hassan has 4+ years of hands-on U.S. medical billing experience — working claims, denials, credentialing, and payer follow-up for practices across the United States. Every guide he publishes is written from real remittances and payer behavior, not theory.

Rejected claims still have a deadline. Check it with our timely filing calculator.

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