Enter claims submitted and claims paid on first pass to get the clean claim rate — plus the monthly rework the gap is costing.
The cheapest dollar in the revenue cycle
A clean claim — accepted and paid on first submission, no edits, no denials, no touches — is the cheapest dollar a practice collects. Every claim that bounces costs staff time (commonly estimated around $25 per rework) and weeks of delay. Enter submissions and first-pass payments, and this calculator returns the rate, the monthly rework count, and what that rework costs.
How to use it
- Enter claims submitted in the period.
- Enter claims paid on first pass — no rejection, edit or denial touches.
- Read the rate against the 95%+ target and the rework bill below it.
The formula
A worked example
2,000 monthly claims with 1,828 clean is a 91.4% rate — typical, not good. The gap is 172 reworked claims, roughly $4,300 of monthly staff cost ($51,600 a year) before counting the payment delay. Lifting the rate to 96% cuts rework in half — and the fixes are unglamorous: eligibility at scheduling, scrubber edits kept current, and the top five rejection reasons actually root-caused.
Estimates only — payer contracts, plan documents and the EOB are always the source of truth, and nothing here is billing, legal or medical advice. The calculator runs entirely in your browser: no patient data is entered, transmitted or stored.