Full switch to electronic business transactions could save health plans and providers $9.4B: 5 findings

Despite health plans' and healthcare providers' continued movement toward electronic business transactions, data suggest the industry at large has room for growth that could result in $9.4 billion in cost savings.

The 2016 CAQH Index analyzed more than 5.4 billion transactions in 2015 to track manual to electronic business transaction conversion. The index measures adoption, costs and provider labor time of common payer-provider business transactions like verifying coverage, payments, claim status and preauthorization.

Here are five findings from the data.

1. Resource-intensive manual transactions cost U.S. healthcare providers up to $11 more per transaction than electronic transaction.

2. Fully transitioning to electronic transactions could save medical providers at least 1.1 million labor hours per week.

3. On average, conducting preauthorization electronically reduced transaction time from 20 minutes to 6 minutes and transaction cost from $7.50 to $1.89.

4. Claims status inquires and verification of eligibility and benefits witnessed consistently high rates of electronic adoption over the past three years.   

5. Room for growth remains for claim attachment transactions, as 94 percent of claim attachments are submitted manually and cost about $6 more to process than electronic attachments.  

Editor's note: The headline of this article was updated at 10:13 a.m. CT on Jan. 18, 2016, to reflect health plans and providers could save $9.4 billion with full conversion to electronic billing transactions, not only hospitals. We regret this error.

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