The Council for Affordable Quality Healthcare (CAQH) published its 2019 Index report on the adoption of electronic administrative transactions. The report also highlights the unrealized benefits of fully transitioning from manual to electronic transactions.

The Index report measures the adoption rate of certain electronic transactions by both health plans and providers. It also provides cost comparisons of manual and electronic transactions on a per claim and aggregate basis.

The transactions measured in the report are eligibility and benefit verification, prior authorization, claim submission, attachments, coordination of benefits, claim status inquiry, claim payment and remittance advice.

The report estimates that the healthcare system can save $13.3 billion by fully adopting electronic versions of these transactions.

According to the Index, health plan electronic transaction adoption increased for prior authorization, attachments, coordination of benefits, claim payment and remittance advice. The adoption rate of electronic eligibility and benefit verifications dropped by one percent. The adoption rate for electronic claim submissions remained steady at 96 percent.

Despite the improving adoption rates, the report highlights the financial burdens of certain transactions. For example, the report estimates that on average, providers spent almost $11 per transaction to conduct a prior authorization manually and nearly $4 using a payer’s web portal. On average, a manual prior authorization required 21 minutes of provider staff time, while electronic prior authorization transactions required four minutes.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA