CAQH Certification Yields $1B Savings

MANAGED CARE December 2009. ©MediMedia USA

Health plans and providers that adopt national information technology standards can save more than $3 billion in three years, according to a study by the Council for Affordable Quality Healthcare (CAQH).

Plans and providers that are certified by CAQH to use its Committee on Operating Rules for Information Exchange (CORE) guidelines showed significant cost savings, accelerated use of real-time electronic transactions, improved claims verifications, and reduced claims denials.

The study assessed six CORE-participating health plans (Aetna, AultCare, Blue Cross Blue Shield of North Carolina, Blue Cross Blue Shield of Tennessee, Health Net, and WellPoint), representing 33 million covered lives and found:

• Electronic verification of eligibility took about seven minutes less than telephone verification (a saving of $2.10 per verification).
• Health plans that were certified saw a return on investment in fewer than 12 months. For example, by switching from telephone to electronic verification of claims, the average annual reduction in administrative costs can be more than $2.5 million per plan.
• Providers that worked with CORE-certified health plans saw 10–12 percent fewer claim denials, resulting in more income.
• Providers that worked with CORE-certified plans saw a 20 percent increase in patients verified before the office visit, reducing their administrative burden.