Which metric measures the proportion of claims paid without denial or rework?

• A. Clean claim rate
• B. Denial rate
• C. Days in AR
• D. Net collection rate

Answer: (A)

The key idea is a measure of submission quality: the clean claim rate. A clean claim is one that the payer can adjudicate and pay without needing any corrections, denials, or resubmission. So, this metric tracks the portion of claims that go through the payer without denial or rework. It’s calculated by dividing the number of clean claims by the total number of claims submitted, usually expressed as a percentage. A higher clean claim rate means fewer delays, less administrative rework, and faster cash flow because more claims are paid on first submission.

Denial rate, in contrast, focuses on the percentage of submitted claims that are denied, which is the opposite of clean submissions and signals issues in documentation, coding, or eligibility. Days in accounts receivable measures how long it takes to collect, reflecting aging and overall cash flow timing rather than first-pass submission quality. Net collection rate looks at actual money collected relative to net allowed amounts, accounting for adjustments and write-offs, which is broader than whether a claim was paid without denial on first submission.