Why does the benchmark vary by specialty?

Coding complexity, modifier density, payer-policy variability, and dominant claim types all shift the achievable ceiling. Oncology and orthopedics run lower (more bundling, more authorizations); dermatology and pediatrics run higher.

Where do the specialty medians come from?

The MGMA specialty benchmark dataset, supplemented with anonymized observations from Medonix's founding U.S. client cohort over the rolling 12 months ending Q1 2026. The full distribution by specialty (median, 75th percentile, top three denial reasons) is published in the Clean-Claim Rate Benchmarks report.

Is 95% the realistic ceiling?

For most specialties, yes. A handful of practices on tight payer mixes hit 97–98%, but those are outliers. Above 95% is best-in-class; pushing past 96% usually costs more than it returns.

Free tool

Clean Claim Rate Benchmark

Name: Medonix MSO
Address: 300 Delaware Ave Suite 210, Wilmington, DE, 19801, US
Telephone: +1-302-520-5413
Price range: $$

Compare your clean-claim rate to MGMA peer data. This calculator is free, requires no signup, and runs entirely in your browser. Medonix never receives your inputs unless you opt in to receive a personalized report by email.

Result

Clean-claim rate

90.0%

Best-in-class: ≥95%. MGMA acceptable: ≥90%.

Family Medicine median

94%

Median first-pass clean-claim rate from Medonix specialty cohort.

Delta vs. specialty

-4.0 pts

Your rate minus your specialty median.

Rework volume / month

240 claims

First-pass rejections that require manual rework.

Below the Family Medicine median (94%) by 4.0 pts.

Methodology

Clean-claim rate: first-pass-accepted claims ÷ submitted claims. The standard MGMA cost-survey definition.

Specialty medians: MGMA specialty benchmark dataset, supplemented with anonymized observations from Medonix's founding U.S. client cohort over the rolling 12 months ending Q1 2026. Full distribution per specialty in the Clean-Claim Rate Benchmarks report.

Frequently asked

About the Clean Claim Rate Benchmark.

A claim accepted by both the clearinghouse scrubber and the payer on first submission, without manual rework, additional documentation, or correction. The MGMA cost-survey definition.

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Clean Claim Rate Benchmark

About the Clean Claim Rate Benchmark.

01What counts as a clean claim?

02Why does the benchmark vary by specialty?

03Where do the specialty medians come from?

04Is 95% the realistic ceiling?

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