The United States healthcare system spends billions each year with manual administrative processes for basic transactions, and transitioning to HIPAA electronic administrative transactions could save $8 billion-plus each year, according to a CAQH report.
The report is based on data collected in the CAQH Index measuring adoption rates, cost and savings associated with electronic business HIPAA transactions between health plans and providers. The 2015 Index includes more than 118 million covered lives and 4 billion transactions in 2014.
Here are five things to know about the report:
1. The average adoption rate varies based on transaction; claims submission has the highest adoption rate while referral certification has the lowest:
• Claim submission: 93.8 percent
• Eligibility and benefit verification: 70.5 percent
• Claim payment: 61.4 percent
• Claim status inquiry: 56.5 percent
• Remittance advice: 49.6 percent
• Coordination of benefits claims: 48.7 percent
• Prior authorization: 10.2 percent
• Referral certification: 6.2 percent
2. The three year trends show substantially more transactions were conducted electronically in 2014 than in previous years.
3. The 2015 Index found significant unnecessary costs in the large volume of manual transactions that could be handled electronically.
4. Healthcare providers could save $5 billion per year with automated processes to check patients' eligibility and benefits. The manual transactions cost providers and plans $2 more on average than the automated transactions.
5. To accelerate the change to electronic transactions, there is a growing need to align administrative and clinical electronic data exchange and share and expand best practices throughout the industry. The report also recommends a government-led outreach and education for all stakeholders.