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New CAQH Report Reveals Significant Differences in Administrative Costs Among Healthcare Providers by Type and Size


WASHINGTONApril 2, 2024 /7Newswire — CAQH published a new report, “Administrative Transaction Costs by Provider Specialty: Results from the 2023 CAQH Index,” which highlights how the time and money spent on common healthcare administrative tasks, like checking insurance and processing payments, vary among different types of healthcare providers and by size of their practices. The medical industry spends an astonishing $83 billion annually on staff time to conduct routine administrative transactions between providers and health plans during and after a patient-provider encounter. Providers shoulder 97 percent of these costs. The analysis shows a significant opportunity for savings, especially for behavioral health providers and small practices, by automating key administrative processes with health plans.

“About three in 10 medical groups experienced a physician departure or early retirement in 2023, often due to burnout. This report pinpoints opportunities to reduce provider workload through standardization and automation, enhancing experiences for both providers and patients,” said Sarah Ahmad, CAQH CEO.

For example, the report shows that behavioral health providers and specialists spend, on average, $14 each time they check a patient’s insurance coverage via phone, fax, or email. This process takes, on average, 24 minutes, which is three times longer than it takes generalists due to the more complex benefits, requirements, and services. Similarly, behavioral health providers and specialists spend, on average, 25 minutes obtaining a prior authorization for a requested healthcare service via phone, fax, or email compared to 14 minutes for generalists. By automating this process behavioral health providers and specialists could save, on average, $8 per authorization.

CAQH urges healthcare providers, especially specialists and behavioral health providers, to review the report’s findings and consider the benefits of automating their administrative processes. This transition not only promises to alleviate the heavy financial burden on providers, but also to reduce burnout among healthcare professionals, enhancing the overall experience for both providers and patients.

Download the report: “Administrative Transaction Costs by Provider Specialty: Results from the 2023 CAQH Index.”

About CAQH

CAQH is a leading organization focused on aligning the healthcare ecosystem around essential solutions, creating a more connected and less costly experience for all. For more than 20 years, CAQH has partnered with millions of providers, thousands of health plans, state Medicaid agencies, and leading healthcare stakeholders who leverage the organization’s solutions, operating rules, and insights to connect and exchange data every day as a part of the business of healthcare. Learn more at CAQH.org.