By Kristine Burnaska, Ph.D.
Despite declining volumes,
cost savings opportunity
According to the 2018 CAQH Index, the U.S. healthcare system has become more efficient, and the cost of doing business may be declining. 1 Automation
has increased across almost all business trans-
actions tracked by the Index, including verifying
a patient’s insurance coverage, submitting a
claim, coordinating benefits for patients with
multiple forms of insurance, checking on the
status of a claim, and sending payments.
However, more work needs to be done. Medi-
cal health plans and healthcare providers could
save an additional $9.8 billion annually by fully
transitioning to electronic transactions. As in
prior years, the majority of the savings opportu-
nity ($8.5 billion) is for healthcare providers.
Historically, a high-volume transaction, claim
status inquiry—which accounts for approxi-
mately a quarter of the total industry savings
opportunity—has been used by healthcare pro-
viders and their revenue cycle vendors to monitor
claim submissions as they progress through
health plan adjudication. Use of this transaction
gave providers an opportunity to intervene if a
claim required rework, preventing denials.