The organization’s 2015 Index found that the U.S. is still spending unnecessary but significant sums of money on manual transactions when the technology is available to handle those electronically.
The U.S. healthcare system is spending billions of dollars by continuing to use manual administrative processes for basic transactions when shifting to HIPAA electronic transactions has the potential to save approximately $8 billion annually, according to the 2015 CAQH Index.
Healthcare providers, in fact, could save more than $5 billion annually by using automated processes to check patients' eligibility and benefits, according to CAQH.
CAQH, a nonprofit dedicated to streamlining the business end of healthcare by measuring adoption rates, cost, and savings associated with the shift from manual to electronic HIPAA transactions between health plans and healthcare providers. As defined by the organization, manual transactions include resource-intensive processes: phone calls to verify patient coverage, or mailing claims and paper checks.
The CAQH Index is based on data submitted by healthcare providers and commercial health plans, which represented over 118 million covered patients (nearly half of the commercially insured U.S. population), and more than 4 billion transactions in 2014.
The report shows that the average rate of adoption of fully electronic transactions varies significantly among the areas measured. Claim submission, for instance, adopted fully electronic transactions at a rate of almost 94 percent, while referral certification had an adoption rate at a scant 6.2 percent. Adoption rates for eligibility/benefit verification and claim payment was relatively high (70.5 and 61.4 percent, respectively), while that of prior authorization was low (10.2 percent).
Coordination of benefits claims, remittance advice and claim status inquiry experienced medium adoption rates (48.7, 49.6, and 56.5 percent, respectively), while claim status inquiry clocked in at slightly higher, at 61.4 percent.
John Bialowicz, manager of the Electronic Business Interchange Group at Blue Cross Blue Shield of Michigan, said in a statement that such findings provide the industry with an opportunity to improve operations by sharing best practices.
"The Index clearly illustrates the value of transitioning to fully electronic transactions," he said.
The 2015 CAQH Index is the third annual report of its kind, enabling an analysis of trends from 2012 through 2014. Three-year trends show that substantially more transactions were conducted electronically in 2014 than in previous years. As in previous reports, the 2015 Index found significant, unnecessary costs resulting from large volumes of manual transactions that could be handled electronically.
Despite increasing use of electronic transactions for eligibility and benefit verifications and claim status inquiries, for example, the industry continues to handle high volumes of these transactions manually.
Healthcare providers alone could save more than $5 billion annually by using automated processes to check patients' eligibility and benefits, according to CAQH.
On average, the group found each manual transaction cost providers and plans $2 more than automated electronic transactions.
For the first time, the Index now includes data about dental plans and providers, representing more than 92 million patients and 440 million transactions. The Index found that, on average, adoption of electronic transactions is 30 percent lower for the dental industry compared to the broader medical healthcare industry.
CAQH also suggested specific recommendations for a speedier adoption of electronic transactions, such as sharing and expanding best practices through industry and government-led outreach and education.
The report also called for an evaluation of federal regulations and strategic plans to assess their sufficiency; another recommendation urges targeted, industry-led efforts to reduce adoption barriers for health plans and healthcare providers, perhaps with financial incentives or contractual requirements.