How to calculate it
Claims accepted on the first submission, divided by all claims submitted, over the same period.
What's good
Strong billing teams aim for the high 90s. If yours is much lower, something upstream is broken.
Common causes of rejections
- Wrong or missing patient demographics or insurance details
- Missing modifiers
- Provider not enrolled with the payer
- Diagnosis and procedure don't match
Most of these can be caught before the claim goes out. See what your billing report should show.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.
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