What is Clean Claim Rate (CCR)?

The Clean Claim Rate (CCR) is a vital Key Performance Indicator (KPI) that measures the percentage of claims submitted to a payer that are processed and paid upon the first submission, without requiring any manual intervention, correction, or appeal.

A clean claim is one that passes through Claims Adjudication successfully the first time. It is the single best measure of the efficiency and accuracy of a provider's RCM process.

Why CCR is Critical for CFOs and Financial Leaders

CCR is a direct predictor of cash flow velocity and RCM operational health.

• Direct Cash Flow Acceleration: Every claim that is not clean becomes rework, delaying payment and increasing Days in Accounts Receivable (A/R). A high CCR means faster, more predictable cash flow.
• Maximized Net Revenue: Claims that fail to be clean on the first pass have a significantly higher probability of being denied outright. Maximizing CCR is a fundamental strategy for maximizing the Net Collection Rate (NCR).

Key Use Cases: How Automation Guarantees a High CCR

Achieving a CCR above 95% is only possible through extensive use of RCM Automation.

• Intelligent Claims Scrubbing: Automated Claim Scrubber tools and AI run every claim against a complex, payer-specific rules engine before submission.
• Front-End Data Integrity: A unified RCM platform ensures that accurate data captured during Eligibility Verification and Charge Capture automatically flows to the claim form, preventing the most common front-end errors that break CCR.

Clean Claim Rate (CCR) vs. Claim Denial Rate

These two KPIs are inversely related:

• Clean Claim Rate (CCR) measures the successful claims paid on the first submission.
• Claim Denial Rate measures the percentage of claims that are denied by the payer.

Resources and Education

• Candid Health Product: Claims Automation /product/claims

RCM Data Reporting: CCR Analytics /data-reporting