Clean-claim rate from 84% to 98.6% in six months.
An ambulatory surgery center was submitting claims at an 84% clean rate — meaning one in six needed rework. Six months of scrubbing and implant-invoice discipline got them to 98.6%.
98.6%
Clean-claim rate
98.6%
Clean-claim rate (from 84%)
+ 14pt
Clean-claim improvement
− 38%
Claim rework volume
6 mo
To target rate
The challenge
Implant invoices weren't being attached, anesthesia time units were inconsistent, and out-of-network claims were underpriced. The 84% clean-claim rate meant constant rework and slow payment.
What we did
- Built an implant-invoice workflow so high-cost devices are carved out and billed separately.
- Standardized anesthesia base and time-unit calculation.
- Repriced and negotiated out-of-network claims to protect margin.
- Added ASC-specific scrubbing rules before submission.
"ClearClaim understood ASC billing on day one. We stopped re-working one claim in six, and the implant carve-outs alone paid for the engagement."
DC
Dana Cole
Administrator, Summit Surgery Center
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