Beyond Clean Claim Rates: Why Touchless Claim Rate Is the New RCM Standard
Imagine revenue cycle management so finely tuned that more than 98% of all claims are submitted and adjudicated correctly without anyone touching them.
- Collections increase, because more claims are submitted correctly the first time without error.
- Costs plummet because software is handling the majority of the repetitive, rote work that otherwise eats up billing teams’ time.
- Practices scale without outsourcing or expanding RCM headcount because existing teams can do more.
You get the idea.
But you can't change what you don't track.
For decades, RCM platforms promised automation. But most systems couldn't track when and where billers manually intervene. And even when problems were identified, the automation available couldn't handle the complexity of the work or keep up with the pace of payer changes.
The technology to do this now exists: granular tracking of every manual touch, combined with automation that can process complex billing logic at unprecedented scale. That's what makes the touchless claim rate (TCR) actionable.
Here's how TCR works.
Touchless Claim Rate, Defined
Touchless claim rate (TCR) is the percentage of claims that are submitted correctly, adjudicated correctly by the payer, and processed automatically all the way through to remittance, without manual intervention.
TCR quantifies the impact of automation in RCM because it shows how often teams avoid time-consuming, costly manual touches.
At Candid Health, the autonomous RCM platform, we use TCR as our core metric because it quantifies the impact of automation.
Traditionally, revenue cycle management teams track metrics like clean claim rate (CCR) – how many claims are accepted for processing by the payer and not rejected.
But metrics like CCR, or even first-pass resolution rate, don't account for broken processes that require a biller to touch a claim five times before a clean submission.
Why Touchless Claim Rate Matters
TCR more accurately measures the success of modern revenue cycle management because it’s not just a measurement of work completed, but of efficiency, which matters more than ever in today’s world of unprecedented scale
When TCR is high, other key metrics improve, too.
Net collection rate rises because more claims are submitted correctly the first time. Billers, freed from working rote claim processing, have more time to focus on complex claims, further driving up NCR.
Cost to collect shrinks dramatically, because the RCM system can now handle more claims automatically, faster. Fewer denials and faster processing leads to fewer claims in queues to work manually.
So do days in accounts receivable. Fewer claims get kicked back for errors, so revenue converts to cash faster with less leakage.
Why Nobody Tracks Touchless Claim Rates
If touchless claim rate matters so much, why isn't every healthcare organization measuring it?
The answer is simple: no revenue cycle management platform could, until Candid Health.
Legacy systems lack the data they need to be truly autonomous. Most RCM systems store claim data, but automating submission so all claims are submitted correctly on the first try requires more information than just what’s on a claim. An autonomous billing system needs underlying data such as provider rosters, credentialing lists, and contract information, to name just a few examples. Without them, no system can automate claim submission correctly.
Legacy systems don't track touches. Most RCM platforms can’t log when and where billers manually intervene in the claims process. The systems weren’t built to enable that. A biller might open a claim five times to correct errors, verify eligibility, update patient information, and resolve a payer-specific requirement before submitting, but none of that is tracked. Calculating touchless claim rate is impossible without that tracking. And, without that tracking available for reporting and review, it’s impossible to identify manual work bottlenecks in order to fix them.
The RCM infrastructure wasn't built for automation. Knowing where manual work happens is only half the equation. The other half requires having the tools and resources to eliminate that work. Most platforms can't automatically edit claims. For example, say a visit at a new location requires a different service address than what is typically used. Without automated claim correction, billers have to manually fix these issues before submission, which lowers TCR.
How Candid Health Drives Touchless Claim Rate
The Candid Health platform drives: comprehensive data consolidation, granular visibility into touches, and self-service automation.
Comprehensive data model
Most RCM platforms don’t have the full picture, so are limited in their ability to automate correctly. Critical clinical information isn’t transferred from the EMR to the RCM platform. Fee schedules and provider credentialing live in different systems or in spreadsheets.
Candid consolidates all of this data into a single, unified model. The platform is built for comprehensive integration into any system by any means, including flat files, EDI transactions (837s/835s) and modern APIs.
The end result is a comprehensive view of everything that drives all downstream automation.
Granular, real-time transparency for actions
The Rules Engine enables automation. But knowing exactly what to automate requires visibility into where billers are spending their time.
Candid tracks each touch a user makes to a claim. The platform logs user actions as well as system actions. This workflow data empowers real-time reporting that shows where manual work concentrates across the revenue cycle.
Revenue leaders can see top-level touchless claim rates, then drill into the data to find patterns: which fields billers are changing most often, which payer rules are triggering the most manual work, which claim types require the most intervention.
For example, one practice discovered their team was touching 112,000 fields per week. Of those, 6,000 touches were just updating a single field from one value to another, and 17,000 weekly touches were changing the same diagnosis code. These patterns revealed automation opportunities that had been invisible to managers.
This visibility turns patterns into action. If billers are correcting the same eligibility error thousands of times a week, managers can see those touches and know exactly what to fix upstream in the process.
Self-service automation at scale
Most billing systems don’t actually edit claims; they just flag which claims fail validations and then route the claim to a person to fix manually. At today’s level of scale and complexity, that isn’t good enough. We reimagined what automation can do:
First, we developed a Rules Engine and other automation that actually edits claims. Our Rules Engine handles complex billing logic that would require manual intervention in other systems
Second, we allow our customers to develop their own rules. Candid ships out-of-the-box with our own rules that we’re constantly reverse engineering across the corpus of claims we submit. On top of that, customers can add and edit their own rules without needing to submit a ticket to Candid to implement.
Third, managing rules at scale is extremely complicated. Tracking how a single claim traversed the rules can feel like trying to trace a single noodle in a large bowl of spaghetti. Rules Engine features like rule testing and versioning help manage rules at scale.
The Candid Health Results
Talkiatry is a leading national provider of psychiatric care. As they scaled, their legacy RCM system couldn't keep up. The platform's limitations forced their billing team into constant manual work.
They needed automation that actually worked.
After switching to Candid Health, Talkiatry reduced transactional work by 40% even as claim volume increased.
"Automation is the next generation of revenue cycle, and I really think Candid will be the ones to take us to the next level," says Charlie Collins, Senior Vice President of Revenue Cycle at Talkiatry.
That's what a high TCR delivers. Not just a number on a dashboard, but real results — the ability to scale, with fewer denials, and faster cash.
Ready to check your TCR? Talk to us.