Clean claim rate is the percentage of insurance claims submitted that are accepted and processed without requiring additional information, corrections, or resubmission.

A clean claim passes through payer adjudication on first touch. Every claim that isn't clean requires human intervention—someone researching the rejection, correcting information, resubmitting, and tracking. This rework is expensive, delays payment, and scales linearly with volume.

Telehealth organizations should target 95%+ clean claim rates. Below 90% signals systematic problems with your billing templates, eligibility verification, or documentation workflows. Common telehealth-specific clean claim failures include incorrect modifier usage (GT, 95, etc.), missing originating site documentation, and state-specific telehealth coverage verification.

Improving clean claim rate often delivers the highest ROI of any revenue cycle investment because it reduces both denial rework and Days in AR simultaneously while improving payer relationships.

Related terms: Claims denial rate, First-pass resolution rate, Reimbursement cycle time