Report: Automated claim transactions linked to billions in savings for healthcare industry

Automating claim transaction saved the healthcare providers, including medical and dental providers, and payers $122 billion in 2019–2020 and moving to fully electronic transactions could yield an additional $16.3 billion in savings, according to the Council for Affordable Quality Healthcare Inc. (CAQH) 2020 Index.

Although many claim transactions are automated, remaining manual processes, such as obtaining prior authorizations, are often complex and resource-intensive, according to the report. The report identified prior authorization as the largest savings opportunity. Converting partially electronic prior authorization transaction to fully electronic could save provider organizations $3.43 per transaction and converting a completely manual prior authorization process to fully electronic could save $6.62 per transaction.

The volume of transactions can also indicate opportunities for savings, according to the report. For example, eligibility and benefit verification is one of provider organizations’ highest-volume transactions, so increasing automation has the potential to result in greater savings.