Ready to help healthcare save $8 billion?

August 3, 2016 ABILITY

The non-profit CAQH (formerly the Council for Affordable Quality Healthcare) has released its annual CAQH Index, which measures the healthcare industry’s shift from manual to electronic claims processes. Now in its third year, the Index aims to highlight the dramatic cost savings that can be achieved in healthcare administration on the part of both providers and payers. This year’s report finds that the industry has an opportunity to achieve more than $8 billion in cost savings annually via wider adoption of electronic transactions.

“By some estimates,” CAQH states, “more than $31 billion each year is spent by healthcare providers alone conducting basic business transactions with health plans. A good portion of this expense can be attributed to resource-intensive manual processes, such as phone calls to verify patient coverage or mailing claims and paper checks.”

The report identifies the following cost savings per electronic transaction:

  • Claim submission: $1.54
  • Eligibility/benefit verification: $8.18
  • Claim status inquiry: $6.26
  • Claim payment: $1.04
  • Remittance advice: $1.56

Publicity like this, of course, is designed to encourage both providers and payers to increase efficiency, but to do that they need the right workflow solutions. While there is a great opportunity for savings in moving away from paper claims and manual eligibility checks, the software and other technology for these tasks must be simple enough to suit providers who are currently still using the old-fashioned processes. But clever solutions, such as schedulers that automatically feed into eligibility checks, can help customers gain greater efficiency from the workflows they already utilize.

With the cost-saving data provided by CAQH, vendors have a more compelling story than ever about the importance of transitioning to electronic transactions. ABILITY is ready to help your organization build the tools customers need for the future.



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