January 2017

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.

Integrating User Feedback to Enhance CAQH ProView

January 2017

More than 1.4 million healthcare providers currently enter and maintain a wide range of information within CAQH ProView®, the industry’s trusted electronic solution for capturing and sharing self-reported provider data. Providers and practice managers enter data free-of-charge into the secure central database and authorize healthcare organizations to access the information, eliminating redundant paperwork and reducing administrative burden. 

User feedback is crucial to drive innovation and enhance developing and existing features to optimize CAQH ProView. Various outreach activities are conducted throughout the year to ensure that ideas and suggestions from healthcare providers and health plans are integrated into the solution.

MetLife Uses EnrollHub to Overcome Challenges to Dental Provider EFT/ERA Enrollment

January 2017

CAQH partnered with dental plan MetLife to host a webinar on their success in increasing provider enrollment in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) through EnrollHub®. This industry-wide CAQH solution makes it easier for providers to receive claim payment and remittance advice electronically from multiple health and dental plans. 

New Video Describes Value and Goals of the CORE Certification Program

January 2017

A new two-minute video by CAQH Commitee on Operating Rules for Information Exchange (CORE®) provides an overview of CORE Certification. This e-program enables entities to demonstrate that they are adhering to the CAQH CORE Operating Rules and underlying standards for administrative data sharing across the healthcare system. Developed by industry for industry, the CORE Certification program is widely recognized as the industry gold standard for testing conformance to the operating rules.  



UPCOMING: CAQH CORE Town Hall National Webinar

February 15, 2017, 2:00 PM ET

CAQH CORE Town Hall webinars provide the public with an update on CORE's recent activities related to industry development and/or implementation of healthcare operating rules. Learn about federally mandated and voluntary CAQH CORE Operating Rules, voluntary CORE Certification, and much more. Register.

UPCOMING: Use and Adoption of Attachments in Healthcare Administration

March 2, 2017, 2:00 PM ET

There has been an expressed need for comprehensive and foundational knowledge on the industry use and adoption of attachments in the administration of healthcare. Register for this webinar to receive an overview of electronic claims attachments including the current exchange standards, the anticipated interim rule, and the key challenges and opportunities for stakeholders. This is the first of a webinar series on attachments. Register.

New CAQH Staff

Kurt Lesniewski, Director of Operations

Kurt will oversee business operations functions that underpin CAQH Solutions, including the support centers, data entry and primary source verification. Prior to joining CAQH, he spent a decade at Comprehensive Health Services, an occupational healthcare company.  Kurt held positions as a Director of Operations and Business Analyst for the line of business focused on required pre-placement exams for employment. 

Adam Nichols, Associate, Certification

As the newest member of the CAQH CORE team, Adam will support many of the day-to-day efforts of the CORE Certification program. Adam studied Health Services Administration at the University of Central Florida.

Hassaan Sohail, Product Manager

Hassaan will focus on CAQH ProView and DirectAssure as a member of the product team. He spent the last three years in product management at The Advisory Board Company. In this role, he worked on enterprise technology solutions for provider organizations.

Michelle Toscano, Senior Manager of Sales

Michelle will be responsible for sales in the Eastern region for CAQH solutions. She joins CAQH from TriZetto (now part of Cognizant). Michelle most recently held the role of strategic account executive where she helped organizations identify the right tools for their specific business needs.

CAQH in the News


Streamlining Provider Data Management Could Save Billions…but Is It Possible? (subscription required)

Report: Administrative simplification standards could save $9.4 billion a year

Full switch to electronic business transactions could save hospitals $9.4B: 5 findings

Electronic healthcare transactions could save the industry $9.4 billion

New report shows how dentists could be saving billions

Wider adoption of electronic transactions could save healthcare $9.4B, report says

Electronic business transactions switchover could save healthcare $9 billion, report says

Healthcare Industry Could Save $9.4B with Full Adoption of Electronic Transactions

Report: Reducing Manual Business Transactions Could Save Healthcare $9.4B

Manual Business Transactions Costing Healthcare Billions

Electronic Claims Management Adoption to Save Providers $7.9B