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.

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