NOTICE: There will be scheduled website maintenance between August 26-27, 2017, which may briefly interrupt access to CAQH.org.

Explorations

New Progress Report Released

Administrative costs in the U.S. healthcare system consume well over $300 billion annually, or nearly 15 percent of all healthcare expenditures by some estimates. A portion of this expense is related to use of resource-intensive manual processes to conduct business transactions between providers and health plans, such as phone calls to verify patient insurance coverage or mailing claim payments.

Voluntary industry-led initiatives, as well as regulatory actions, have established standards and requirements to facilitate an industry-wide transition from these costly manual processes to electronic, real-time transactions. 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 opportunities for further industry action.

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 providers as well as 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 46 percent of commercially insured U.S. population—and 564 million transactions conducted in 2015. Some estimates contained in this report focus on specific subsets of transactions types, based on the availability of data from participating health plans.