Explorations

New Progress Report Released

An industry-wide transition to replace manual processes with electronic, real-time transactions is ongoing to reduce the cost of doing business in healthcare and meaningfully impact efficiency, productivity, and data quality. Several key industry-led initiatives, as well as legislative and regulatory actions, have propelled adoption of electronic claims-related transactions forward, with incremental progress occurring over recent decades and accelerating dramatically in recent years. Measuring the progress of this transition helps identify which electronic transactions are being adopted successfully and which are being adopted at a slower pace, highlighting a potential need for targeted support to further drive greater adoption.

The CAQH Index® is the industry source for monitoring this transition. This annual report presents trends in adoption rates and cost savings associated with the shift to electronic transactions, based on surveys of healthcare providers and health plans. Participating health plans represent over 118 million covered lives – nearly 45 percent of the commercially insured U.S. population – and more than 4 billion claims-related transactions conducted in 2014. The 2015 CAQH Index includes several notable enhancements. Specifically, the Index now analyzes adoption rates for coordination of benefits (COB) claims and referral certifications. It also includes data from the dental industry, representing over 92 million covered lives and 440 million transactions – over 40 percent of the U.S. population with commercial dental insurance.

2016 CAQH Index Data Collection

The CAQH Index is an ongoing measure of progress to electronic business transactions. The 2016 CAQH Index Data Collection Template for Payers is now availalble for health plans to submit data for numbers of transactions and costs per transaction, manual vs. electronic, for calendar year 2015.