2016 CAQH Index Highlights Adoption, Costs and Savings from Electronic Claims-Related Transactions

January 2017

Widespread adoption of electronic business transactions in healthcare continues to grow but a significant opportunity for $9.4 billion in annual savings remains, according to the 2016 CAQH Index®, released earlier this month. Conducting resource-intensive manual transactions costs U.S. health plans and healthcare providers as much as $11 more per transaction and on average $6 more than when conducted electronically. Millions of these transactions are exchanged daily. 

The fourth annual CAQH Index measures adoption, costs and, for the first time, provider labor time associated with the most common administrative transactions conducted between health plans and providers. These include verifying a patient’s insurance coverage, sending and receiving payment, inquiring about the status of a claim and obtaining prior authorization for care. 

New findings show that medical providers could save at least 1.1 million labor hours per week by transitioning to fully electronic transactions. Providers now spend 8 minutes on average, and up to 30 minutes on manual tasks, which include making phone calls, sending faxes and mailing correspondence. Prior authorization offers providers the greatest time savings potential if conducted electronically, reducing the time per transaction from 20 to 6 minutes and the cost from $7.50 to $1.89.

The potential savings from full industry adoption of electronic transactions grew by nearly one billion from what was reported in the CAQH Index last year. This growth is due in part to including an additional transaction to the six that were previously measured. Claims attachments, the added transaction, are used to send extra information required for some healthcare claims, such as discharge summaries or operative reports. Of note, 94 percent of claim attachments are currently submitted manually, which each cost nearly $6 more to process compared to electronic attachments. The collection of more precise data on cost savings for providers this year also contributed to the reported increase. 

Beyond medical savings and cost, the CAQH Index tracked for the second year adoption of electronic transactions by dental health plans and providers, and for the first time the cost savings. Adoption of the four electronic transactions measured for commercial dental health plans was on average 30 percent lower than adoption by commercial medical health plans. This gap presents a significant savings opportunity for the dental market. Full electronic adoption of the transactions studied could save dental health plans nearly a half billion dollars and dental providers more than $1 billion in labor costs.

The 2016 CAQH Index stresses the savings potential available to the healthcare and dental industry through full adoption of electronic business transactions. To encourage greater adoption, the report proposes that the industry share best practices, conduct targeted industry-led efforts to reduce adoption barriers and perform systemic reviews of current standards, codes, operating rules and policies.

The findings from the 2016 CAQH Index are based on voluntary nationwide surveys of providers, as well as commercial medical and dental health plans. Participating medical health plans represent over 140 million covered lives—nearly 46 percent of the commercially insured U.S. population—and 5.4 billion transactions conducted in 2015. Participating dental health plans represent 112 million covered lives—about 43 percent of commercially insured U.S. population—and 564 million transactions conducted in 2015. 

A copy of the full report is available at www.caqhindex.org, along with a webinar explaining the findings.

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