Administrative automation could save health care industry $16.3B per year

‌ ‌“Eligibility‌ ‌and‌ ‌benefit‌ ‌verification,‌ ‌the‌ ‌top‌ ‌savings‌ ‌opportunity‌ ‌for‌ ‌medical‌ ‌plans‌ ‌and‌ ‌providers,‌ ‌experienced‌ ‌a‌ ‌37%‌ ‌increase‌ ‌in‌ ‌savings‌ ‌opportunity‌”‌ ‌according‌ ‌to‌ ‌the‌ ‌Index.‌ ‌‌ (Photo: Shutterstock)

The‌ ‌U.S.‌ ‌health‌ ‌care‌ ‌industry‌ ‌would‌ ‌save‌ ‌$16.3‌ ‌billion‌ ‌per‌ ‌year‌ ‌by‌ ‌fully‌ ‌automating‌ ‌nine‌ ‌common‌ ‌administrative‌ ‌transactions,‌ ‌according‌ ‌to‌ ‌the‌ ‌‌2020‌ ‌CAQH‌ ‌Index‌‌ ‌—‌ ‌thanks‌ ‌to‌ ‌a‌ ‌drop‌ ‌in‌ ‌costs‌ ‌for‌ ‌automated‌ ‌processes‌ ‌and‌ ‌higher‌ ‌costs‌ ‌for‌ ‌manual‌ ‌and‌ ‌partially‌ ‌electronic‌ ‌portal‌ ‌processes.‌ ‌ ‌ ‌ “This‌ ‌year’s‌ ‌report‌ ‌found‌ ‌that‌ ‌adoption‌ ‌of‌ ‌electronic‌ ‌processes‌ ‌generally‌ ‌increased‌ ‌across‌ ‌the‌ ‌medical‌ ‌and‌ ‌dental‌ ‌industries,”‌ ‌Kristine‌ ‌Burnaska,‌ ‌director‌ ‌of‌ ‌research‌ ‌and‌ ‌measurement‌ ‌at‌ ‌CAQH,‌ ‌the‌ ‌nonprofit‌ ‌alliance‌ ‌of‌ ‌health‌ ‌plans‌ ‌and‌ ‌related‌ ‌associations,‌ ‌said‌ ‌in‌ ‌a‌ ‌‌statement‌.‌ ‌“The‌ ‌data‌ ‌also‌ ‌indicates‌ ‌that‌ ‌future‌ ‌efforts‌ ‌to‌ ‌automate‌ ‌could‌ ‌yield‌ ‌even‌ ‌greater‌ ‌returns.”‌ ‌

Related: Not just the bills: Health care’s administrative ‘sludge’ eating up employees’ time ‌ The‌ ‌CAQH‌ ‌Index‌ ‌tracks‌ ‌automation,‌ ‌spending‌ ‌and‌ ‌savings‌ ‌opportunities‌ ‌for‌ ‌administrative‌ ‌transactions‌ ‌related‌ ‌to‌ ‌verifying‌ ‌patient‌ ‌insurance‌ ‌coverage‌ ‌and‌ ‌cost-sharing,‌ ‌obtaining‌ ‌authorization‌ ‌for‌ ‌care,‌ ‌submitting‌ ‌claims‌ ‌and‌ ‌supplemental‌ ‌information,‌ ‌and‌ ‌sending‌ ‌and‌ ‌receiving‌ ‌payments.‌ ‌It‌ ‌categorizes‌ ‌transactions‌ ‌by‌ ‌whether‌ ‌they‌ ‌are‌ ‌fully‌ ‌automated,‌ ‌partially‌ ‌electronic‌ ‌or‌ ‌manual.‌ ‌(The‌ ‌2020‌ ‌Index‌ ‌collected‌ ‌data‌ ‌from‌ ‌health‌ ‌plans‌ ‌and‌ ‌providers‌ ‌through‌ ‌ the‌ ‌2019‌ ‌calendar‌ ‌year‌ ‌and‌ ‌does‌ ‌not‌ ‌include‌ ‌the‌ ‌impact‌ ‌of‌ ‌COVID-19‌ ‌on‌ ‌health care‌ ‌administrative‌ ‌transactions.)‌ ‌ ‌‌