Executive summary
First pass yield is one of the best predictors of cash flow stability. This playbook explains how to measure it correctly, identify the drivers, and improve it without expanding headcount.
What first pass yield actually measures
- Percentage of claims that pay correctly on first submission, by payer and service line
- A leading indicator for AR growth, denial risk, and rework cost
- A better operational signal than overturn rate or gross collections
Common reasons first pass yield falls
- Eligibility and coordination of benefits errors at scheduling
- Authorization and medical policy misalignment
- Coding and charge capture delays, especially across locations
- Provider enrollment or location mismatches that trigger payer edits
A practical operating cadence
- Weekly: payer and denial exceptions review with upstream owners present
- Monthly: root cause top 5 and workflow correction plan
- Quarterly: policy updates, training refresh, and edit rule review
Targets and segmentation
- Track by payer and service category, not just overall averages
- Separate technical denials from clinical denials
- Use a short list of measures: first pass yield, clean claim rate, rework hours, appeal volume
Next step
Start with one payer and one high-volume service category. Build the root cause list, assign owners, and measure first pass yield and rework hours for 30 days.