Case Study
2026
How We Achieved a 99% Clean Claim Rate and Cut Rejections by 86%
We improved claims workflow, coding, eligibility checks and the multi-specialty group achieved a 99% clean claims rate, 86% fewer claims were rejected, and it was paid 42% sooner.
Clean Claim Rate
99% ↑ 20% Improvement
⬇ 86% Claim Rejection Reduction
Key Results Achieved
Clean Claim Rate
79%
→
99%
↑ 20% Improvement
Claim Rejections
14%
→
2%
↓ 86% Reduction
Days to Pay
38
→
22
↑ 42% Faster
Denial Rate
8.2%
→
1.5%
↓ 82% Reduction
⚠ The Challenge
- Low clean claim rate (79%) causing payment delays
- High rejection rate (14%) due to coding errors and missing information
- Frequent payer denials due to incorrect modifiers and diagnosis codes
- Manual claim scrubbing process prone to human error
- Lack of real-time eligibility verification leading to avoidable rejections
- Inefficient appeals process for denied claims
💡 Our Solution
- Implemented AI-driven claim scrubbing and validation
- Automated pre-submission eligibility checks
- Standardized coding protocols and documentation guidelines
- Established daily claim audits and quality assurance checks
- Deployed dedicated denial prevention team
- Integrated real-time payer rule updates into workflow
💰 $420,000+ Additional Revenue Realized
📉 86% Fewer Claim Rejections
Clean Claim Rate Improvement Over 6 Months
Before 79%
After 99%
Our Clean Claims Journey
Week 1
Claim Audit & Gap Analysis
Week 2
AI Scrubbing Implementation
Week 3
Coding Standardization
Week 4
Eligibility Automation
Week 5
Quality Assurance Setup
Week 6+
Sustained 99% Clean Claims
❝ Billing Care Solutions helped us achieve 99% clean claims for the first time. Our rejections plummeted, and we are getting paid faster than ever. This has been a game-changer for our revenue cycle.
99% Clean Claim Rate
86% Rejection Reduction
42% Faster Payments
82% Denial Drop
