A CAQH study, conducted by IBM Global Business Services, assessed results achieved by six CORE-certified health plans that represent 33 million covered lives (Aetna, AultCare, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee, Health Net, and WellPoint affiliated health plans), as well as leading provider groups and vendors using the Phase I CAQH CORE Operating Rules. The study analyzed data from the three-month period prior to health plan certification and one year later. Study results showed that CORE Certification dramatically cuts administrative costs and accelerates HIT adoption by both health plans and providers.

Based on results from the study, an industry-wide implementation of the CAQH CORE Operating Rules could yield $3 billion of savings in three years.

Key findings include:

  • Electronic insurance eligibility verifications took approximately seven minutes less than telephone verifications, saving providers $2.60 per verification. There are more than 1 billion claims verified for eligibility each year in the U.S.
  • Providers working with CORE-certified health plans saw 10-12% fewer claims denials, resulting in improved practice payment.
  • Providers working with CORE-certified health plans saw a 24% increase of patients verified prior to a visit, significantly reducing administrative burden at the point of care.
  • Health plans that became CORE-certified had a payback in less than 12 months. For example, by switching from telephone to real-time electronic claims verification, the average annual reduction in administrative costs can be more than $2.5 million per plan.

Read the press release.

View/download the study Executive Summary.

Organization Type
CAQH Program