What counts as first pass?
State whether the event is clearinghouse acceptance, payer acknowledgement, or another defined status. Those events are not interchangeable.
Input-based calculator
Clean claim rate calculator
Use aggregate claim counts and a written first-pass definition to calculate a rate. The tool does not add a benchmark or forecast an outcome.
Define, then calculate
Use one rule for the numerator and denominator
Inputs and results remain in your browser. Enter aggregate counts only—never claim-level or patient information.
Enter aggregate claim counts
Use the same measurement period, claim unit, exclusions, and written clean-claim definition for both values. Do not enter patient information.
Entries are valid.
Definition controls the result
Document these choices before comparing clean-claim rates
“Clean claim” is not useful as a comparative metric until the unit, event, period, and exclusions are explicit.
What is the claim unit?
Define whether original claims, replacement claims, service lines, encounters, or submissions are counted.
What is excluded?
Document voids, test claims, encounters held before submission, corrected claims, secondary claims, and any other excluded activity.
Where do counts come from?
Identify the source reports, control totals, refresh timing, reconciliation method, and owner responsible for resolving differences.
Source context and review record
Last content review: August 6, 2026. This page uses only the displayed arithmetic definition. CMS describes electronic billing and the transaction responses used in claim workflows; your documented metric definition must still match your systems and reporting purpose.
Need to trace first-pass exceptions?
Define the event, reconcile the source counts, categorize exceptions, assign owners, and connect recurring causes to the workflow that created them.