CAQH Index Report

The business of healthcare in the United States can and should be simpler, less burdensome and, perhaps most of all, less costly. One study projected administrative costs to reach $315 billion by this year, nearly as much as the 10 highest-spending state Medicaid programs paid combined in 2016 to provide care for more than 46 million beneficiaries.

While the sources of excessive administrative costs are many, one important driver is the use of time-consuming manual business processes – phone, fax or mail – to conduct claims-related transactions between healthcare stakeholders, including payers, providers and the vendors that facilitate their transactions. Longstanding healthcare industry-led efforts and government mandates have sought to rein in some of those costs by transitioning the industry to fully electronic administrative transactions.

The 2017 CAQH Index is the fifth annual report assessing industry progress to reduce the use of manual transactions and eliminate cost. It relies on data submitted through a voluntary, survey-based process. Data was submitted from health plans covering more than half of the commercially insured U.S. population in the year studied based on enrollment reported in AIS’s Directory of Health Plans: 2017. Medical health plans contributing data covered 155 million lives, or approximately 51 percent of U.S. commercially insured covered lives. The data submissions represent 1.6 billion claims and over 6 billion total transactions. Dental health plans contributing data represented nearly 50 percent of the covered dental lives. Dental data submissions represent 650 million transactions.

CAQH Program: