Dive Brief:
- Manual administrative processes cost the U.S. healthcare industry about $8 billion a year, according to the 2015 CAQH Index report released Wednesday.
- This is the third annual report by the nonprofit, which analyzed more than 4 billion transactions in 2014, and showed adoption of fully electronic transactions varies among the measured transactions, some of which include claim payment, prior authorization, and referral certification.
- Substantially more transactions were conducted electronically in 2014 than in previous years.
Dive Insight:
Healthcare providers could save more than $5 billion every year by automating processes to check patient eligibility and benefits, the report found. In addition, manual transactions cost plans and providers $2 more each than automated transactions.
“With this solid understanding of where we are today, our industry has a real opportunity to fill some of these gaps and improve operations by sharing best practices,”Manager of Electronic Business Interchange Group at Blue Cross Blue Shield of Michigan John Bialowicz said in a prepared statement.
“The [CAQH] Index clearly illustrates the value of transitioning to fully electronic transactions," Bialowicz said.
The average rate of adoption of the measured fully electronic transactions varied in the study:
- Claim submission - 93%
- Eligibility and benefit verification - 70.5%
- Claim payment - 61.4%
- Claim status inquiry - 56.5%
- Remittance advice - 49.6%
- Coordination of benefits claims - 48.7%
- Prior authorization - 10.2%
- Referral certification - 6.2%
Evaluating federal regulations and reducing electronic transaction adoption barriers for health plans and healthcare providers are among the recommendations the nonprofit highlighted in the report as it believes the findings "demonstrate an urgent need for the industry to change."