CAQH Certification Yields $1B Savings


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.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.