The Council for Affordable Quality Healthcare (CAQH) has let out its 2015 catalog of electronic transaction adoption rates. The organization is a non-profit alliance of health plans and trade associations, which is known for developing and leading initiatives for improving healthcare. The index is released annually, and through it, CAQH tracks and reports progress made by the healthcare industry in the move from manual to electronic admin transactions.
The Health Insurance Portability and Accountability Act (HIPAA), which was passed in 1996, was meant to standardize transactions across all of healthcare, but even though such a heavy focus was placed on the privacy and security standards, there has been fairly little simplification in the objectives of the law. CAQH was formed to organize the many sectors of the healthcare industry so as to standardize and improve admin processes. The Index analyzes data from 2014 on HIPAA business transactions across healthcare, covering both health plans and healthcare providers. The 2015 Index has analyzed more than four billion individual transactions.
With some of the adoption rates being high, the low rates are drawing attention. One example is that of prior authorization, which specifically refers to the formal ASC X12N 278 standard. Many providers use payer-specific web portals to authorize payments, although this isn’t seen as standard electronic claim. That is in spite of it being done on an electronic transaction medium. Meanwhile, more traditional examples of manual transactions are also in existence for prior authorization transactions, like phone calls.
In terms of prior authorization, CAQH places the obligation of improving adoption rates on health plans. Based on the apparent lack of adoption by health plans of fully electronic transactions as a support structure for submission of prior authorization attachments, some providers may well have no alternative to web portals and manual processes which allow submission entailing supporting documentation.
Also evaluated by the index are the costs of each transaction, as well as estimates that $8.5 billion can be had in savings, in the event that the industry switches to exclusively using electronic business transactions. Estimates by the index show that over $31 billion is spent each year on basic business transactions with commercial health plans. A lot of this cost can be heaped at the feet of non-electronic (manual) processes like phone calls or paper claims. The data reported in the Index, by admission, cannot be used to mark a trend, owing to the observations ranging only over a few years.