1. Health plans representing 45 percent of the commercially covered population in 2013 provided data on more than 4 billion transactions and 1.4 billion claims submitted.
2. For fully electronic (HIPAA standardized) transactions, adoption rates in 2013 were: claim submission (92 percent), eligibility and benefit verification (69 percent), prior authorization (7 percent), claim status inquiries (54 percent), claim payment (58 percent) and remittance advice (47 percent).
3. Adoption rates of fully electronic transactions rose slightly between 2012 and 2013.
4. Fully electronic standardized transactions grew in 2013, mostly for claim status inquiries. The largest decline in the volume of manual transitions was for remittance advice.
5. For health plans, manual transaction costs averaged about $2 per transaction. Costs of electronic transactions range from five to 10 cents per transaction.
6. Healthcare providers’ estimated costs per transaction averaged more than $5 for manual transactions and approximately $1.60 for each electronic transaction
“The CAQH Index shows that additional progress to realize the full potential of electronic transactions requires an ongoing commitment by all healthcare stakeholders, including health plans, providers, vendors and government,” says Robin Thomashauer, Executive Director, CAQH. “Findings can inform industry initiatives such as CAQH CORE and CAQH Solutions that support the move towards greater use of electronic transactions.”
Health plans and providers can estimate their potential cost savings by using an interactive savings calculator available at www.caqh.org.
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