First-Pass Resolution Rate (FPRR)
First-Pass Resolution Rate is the percentage of claims paid on initial submission without requiring rework, correction, or resubmission — the primary measure of claims processing efficiency with an industry benchmark target of 95% or higher.
What is First-Pass Resolution Rate?
Also called First-Pass Payment Rate or Clean Claim Rate, FPRR is calculated as claims paid on first submission divided by total claims submitted, expressed as a percentage. The industry benchmark of 95%+ represents best practice; an FPRR below 90% indicates significant billing process failures requiring systematic intervention. Common causes of first-pass failure span front-end and back-end revenue cycle: demographic errors (incorrect date of birth, invalid subscriber ID, name mismatch), insufficient medical necessity documentation, missing prior authorization, missed timely filing deadlines, invalid diagnosis-to-procedure code combinations, and missing or incorrect modifiers. The financial cost of denials is significant. Per HFMA research, reworking a denied claim costs between $25 and $118 per claim in staff time, resubmission overhead, and follow-up. At a 5% denial rate on 10,000 monthly claims, that is 500 denied claims per month — generating $12,500 to $59,000 in monthly rework costs, plus the cash flow delay of 30–90 additional days to collect. FPRR should be analyzed by payer, by provider, by procedure code, and by denial reason code to identify systematic patterns rather than one-off errors.
Why It Matters for Healthcare Analytics
FPRR is both a leading indicator of NCR and a direct measure of billing staff productivity. A low FPRR strains AR aging (as denied claims accumulate in the 60–90 day buckets), increases the risk of timely filing write-offs, and creates a backlog that can cause clean claims to be delayed. Understanding denial reason code patterns — specifically whether denials are eligibility-related, authorization-related, or coding-related — dictates the right operational fix.
How Vizier Tracks First-Pass Resolution Rate
Upload your claims and ERA data, then ask "What are our top denial reason codes by payer and what is the revenue impact?" — Vizier calculates FPRR by payer and provider, categorizes denial reasons, and projects the monthly cost savings from eliminating the most common first-pass failure categories.