Administrative functions are a necessary component of the business of healthcare to ensure that consumers can access quality care and that providers are compensated for delivering that care. However, when the time and money spent on administrative functions is excessive, fewer resources are available for patient care.
In the United States, the healthcare industry has been working collaboratively for more than two decades to reduce the resources spent on administrative functions. Still, recent research estimates that administrative costs in the United States are more than twice that of other developed countries. Other studies estimate that 10 percent of national health expenditures are due to administrative complexity that could be eliminated without harming consumers or care quality.
The 2018 CAQH Index report, the sixth produced annually by CAQH, is the industry resource for benchmarking progress to reduce a portion of this administrative complexity. The CAQH Index tracks adoption of HIPAA-mandated and other electronic administrative transactions for conducting routine business between healthcare providers and health plans in the medical and dental industries. These transactions include verifying a patient’s insurance coverage, obtaining authorization for care, submitting a claim and supplemental medical information and sending and receiving payments. The CAQH Index also estimates the annual volume of these transactions, their cost and the time needed to complete them.
By benchmarking progress, industry and government can more easily identify barriers that may be preventing stakeholders from realizing the full benefit of electronic administrative transactions. These insights can prompt new initiatives to address and reduce barriers.