Government policymakers and industry leaders are searching for ways to reduce costs and improve quality in the US healthcare system. Incredibly, there is a $9.4 billion savings opportunity nearly everyone seems to overlook—and that is a conservative estimate.
A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers and providers, particularly financial and administrative data, and it costs us all a fortune. Manual processes can add more than $9 to the cost of each healthcare transaction compared to processing the same transaction electronically. It also takes an average of 11 minutes (and up to 30 minutes) longer and results in many more errors. Multiplied by the billions of transactions annually, this waste adds up.
What can we do about this waste? CAQH CORE is a non-profit that brings entities across the healthcare industry together to encourage automation by promoting a common set of rules and underlying standards governing electronic data exchange. To highlight which entities are meeting – or exceeding – these rules and standards, CAQH CORE has developed a certification program. Today, with more than 300 certifications awarded so far, this program has become something like the Good Housekeeping Seal of Approval for the industry, and an important indicator of whether or not business partners will be able to share electronic data seamlessly and securely.
Availity completed the CAQH CORE technical testing process and has been awarded certifications for the first three phases of operating rules. These phases cover a variety of transactions, including electronic eligibility and claims status checks, funds transfers, and electronic remittance advices.
For the healthcare industry, CORE Certification means less paper and greater efficiency. Companies will have confidence that they can interconnect smoothly with partners and vendors who are CORE Certified.
But companies aren’t the only ones to benefit from CORE Certification. For consumers, it will usher in a new era in healthcare with fewer errors, less frustration, better privacy protection and, over time, lower administrative costs. Patients and their doctors will know instantaneously if insurance will cover a given procedure. And, when necessary, doctors can receive prior authorization more quickly to avoid delays and unnecessary additional visits.
So, while elected officials continue to wrestle over how to create a better healthcare system, the industry is coming together and doing some important work on its own.
Click here to learn more about the CAQH CORE Certification.