2021 CAQH Report: Potential Savings Up 32% for Healthcare Transactions

March 08, 2022 By: Quadax

Report finds automation of most healthcare transactions increased even though transaction volume decreased due to the impact of the pandemic. 

Potential savings from automating common healthcare administrative transactions increased 32% due to higher costs for more complex manual transactions due to the demands of working through a national pandemic, finds the 2021 CAQH Index. 

Adoption of electronic transactions improved for most medical transactions by 2.3 percentage points. As COVID-19 forced people to work from home and practice social distancing, health plan and provider staff did not have access to office equipment and/or were closed temporarily, meaning staff relied more on the use of electronic transactions to conduct administrative transactions. Conversely, medical transaction volume was down 11% due to healthcare policies, regulations, resources and social behaviors.

Automating prior authorizations saw one of the most significant improvements, jumping from 21% to 26%, yet prior auth volume decreased 23% due to suspensions, waivers, reductions in medical services and freezes on elective procedures during the early months of the pandemic. By switching to electronic methods, the potential cost savings increases to $437 million annually. And the surge in automation doesn't just save money; providers saved, on average, 16 minutes per transaction by conducting prior authorizations electronically.

However, the medical industry is still leaving $17.6 billion in cost savings on the table. Other areas that are rife with opportunities include:

Eligibility and Benefit Verification has the highest opportunity for increased medical cost savings—$9.8 billion or an increase of 45% over 2020.

  • Quadax’s Insurance Eligibility solution confirms payer coverage and benefits information (including copays, coinsurance and deductibles) electronically to more than 800 payers, in real time or batch throughout the billing process — from scheduling, pre-registration, registration to discharge. The solution provides enhanced services surrounding the request, response and review of a patient’s insurance eligibility.

Claim status inquiry is the second highest cost savings opportunity. By switching to electronic transactions, the medical industry could save $3.1 billion.

  • Advanced Claim Status by Quadax automates costly, manual and unnecessary follow-up tasks related to the status of claims as they move through the adjudication process. Using client-defined business rules, the ACS engine will query a claim’s status by polling the payer’s web portal with advanced screen-scraping technology to ensure the most up-to-date and actionable payer responses. Based on the responses, claims that require immediate action can be routed to the responsible party to accelerate claim follow-up. Comment records are delivered back to the EHR and/or billing application sooner so staff can work smarter.

Electronic claim submission increased and remains one of the highest levels of electronic adoption at 97%. The cost savings opportunity associated with switching to the electronic standard more than tripled to $1.7 billion due to the increase in manual provider volume and cost per transaction coupled with a decline in electronic cost.

  • A four-time KLAS award winner, Xpeditor™ by Quadax automates your healthcare claim processing with comprehensive, accurate standard edits, plus edits custom to your organization, customized data conversions to overcome shortcomings in your claim generation routines, and auto-correct rules and advanced workflow to give you the greatest precision and control in your claims management. Quadax edits are constantly updated and refined, yielding a 99.6% first-pass rate, for fast reimbursement.

The Right Technology Partner
The right revenue cycle partner can help you automate these manual processes and enable your team to maximize your bottom line. Our commitment to reliable, expert, personal support is one of our greatest strengths, given our extensive history of meeting a variety of billing, reimbursement, and industry challenges. We personally work with every client to help them use our products in the best way to meet their distinct needs and goals. 

Let’s take on the revenue cycle together!

CAQH is a non-profit alliance of health plans and trade associations focused on the business of healthcare. The ninth annual report measures national progress in reducing the costs associated with conducting administrative transactions in the healthcare industry. The CAQH Index tracks the adoption of Health Insurance Portability and Accountability Act (HIPAA) mandated transactions, as well as other administrative transactions related to verifying insurance coverage, obtaining authorization for care, submitting a claim, attaching supplemental information and sending and receiving payments.


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