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What does claims paid first time mean for a medical practice?
Claims paid first time, or first-pass payment rate, is the number of claims paid in full on first submission divided by claims submitted, multiplied by 100. It shows how clean your billing is before any rework.
It matters because every claim not paid first time requires correction, resubmission and waiting, which adds cost and delays cash.
Commonly misread:
- Counting a claim as paid when it was partly paid or short-paid.
- Using claims still outstanding as if they were failed.
- Mixing claims across different payers with different rules.
Analyse by payer, practitioner, billing code and reason for non-payment. Matching remittance advice to submitted claims is needed, as the payment record shows what the payer actually did with each claim.
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