Savings Spotlight: Claim Status Inquiries

March 2019

Of the many business transactions measured in the 2018 CAQH Index, claims status inquiries offer the healthcare system the greatest per-transaction opportunity for cost savings. Despite fewer claim status inquiries occurring overall compared to the prior year, a significant savings opportunity remains because the transaction is highly inefficient when not conducted electronically. According to the most recent Index, the medical industry could still save an estimated $2.6 billion annually by completing the transition to electronic claim status inquiries.

For claim status inquiries, the Index found that providers can save an estimated $2.3 billion annually, more than 27 percent of the study’s total $8.5 billion potential healthcare provider savings opportunity. In addition, health plans can save $328 million annually, nearly 25 percent of the $1.3 billion health plan savings opportunity by using electronic claim status inquiry transactions.

In prior years, claim status inquiries were often used as a routine transaction. However, the transaction is now typically conducted when there is a suspected issue with a particular claim. CAQH Director of Research and Measurement, Kristine Burnaska, notes that this fundamental shift may be attributable to cleaner claims, faster payments and value-based payment contracts.

Visit www.caqhindex.org to learn more about the CAQH Index, explore additional findings on claim status inquiries, and review progress in electronic adoption and savings opportunities for other common business transactions.

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