About Clean Claim Reports

Clean Claim Report

A clean claim is a claim with no defect or impropriety, no lack of required substantiating documentation or no circumstance requiring special treatment that prevents timely payment. The current status of a claim is calculated by dividing the number of claims passing all edits without manual intervention by the total number of claims accepted into a claims processing tool for billing ((ACC + ACK) / (ACC +ACK + REJ)). Claims with a status of Pending or Completed are excluded from the calculation.

The table below shows fields, filters and columns for both prior versions and updates made for 12.8 to aid in understanding what has changed.

Number	Field	Prior to v12.8 Description	v12.8 Description
1	Calculation (for current status)	CURRENT STATUS = (ACC + ACK) / ALL STATUSES* *PENDING *ACKNOWLEDGED *ACCEPTED *REJECTED *COMPLETED)	CURRENT STATUS = ((ACC + ACK) / (ACC + ACK +REJ) *Claims with CURR status = PENDING or COMPLETED are excluded from the calculation
2	Filters	Run Summary Sec Type Group Division Billing Area Provider Group	N/A
3	UI Columns/Grid	Date Submitted Total Claim Count Accepted/Acknowledged Count Clean Claim %	Date Submitted Total Claim Count Rejected Claims Count Accepted/Acknowledged Count Clean Claim %
4	Drill Down/Hyperlink	Run Summary	Rejected Claims Drills to Claims > Rejected Claim report with filters
5	Color Bar	Red - Percentages between 0.00 - 92.99. Yellow - Percentages between 93.00 - 96.99. Green - Percentages between 97.00 - 100.	N/A
6	Clean Claim Average	CALC= Average of Averages	CALC= Average of the data set Refreshed on filter *Average of Averages is discontinued*
N/A	Dashboard Quick Link	Displays global CCR for default 90 days	Updated to revised calculation

Clean Claim Trend Report

This trending report displays data points representing the clean claim rate by day. The x-axis is labeled for each week beginning on Monday. Upon hover over data points a ToolTip displays the specific date and percentage.