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Rhapsody Health Solutions Team

Interoperability value for health plans and payers

Cut the Costs of Claims-Related Transactions

Processing claims-related transactions through a data clearinghouse comes at a high administrative cost. In fact, healthcare organizations spent about $40 billion in 2019 in administrative transactions, according to CAQH, a non-profit alliance of health plans and related associations. This includes transactions such as: 

 – Eligibility and Benefit Verification 

 – Prior Authorization 

 – Claims Submission 

 – Coordination of Benefits 

 – Claim Status Inquiry 

 – Claim Payment 

 – Remittance Advice 

Many health plans use data clearinghouses for these transactions. Whether the clearinghouse charges a flat rate or per-transaction, the costs add up. Cutting the middleman for just one of these categories can save payers and health plans considerable costs. 

In the infographic Cut the Costs of Claims-Related Transactions, we illustrate how an integration engine can bypass the clearinghouse for Eligibility and Benefits Verifications.  

Why Eligibility and Benefit Verifications? Because health plans make approximately 30 of these transactions per member per year according to the 2019 CAQH Index. 

Our interoperability solutions – Corepoint and Rhapsody – can be configured to route transactions and facilitate the process of verification, thus eliminating the need for a clearinghouse and providing significant cost savings.

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About Rhapsody

Rhapsody partners with healthcare organizations around the globe delivering its adaptable Interoperability Suite to reliably connect, classify, and clean data. Rhapsody health solutions power the applications and workflows that improve clinical, operational, and financial outcomes today while helping teams respond to and prepare for changes on the horizon. Rhapsody is committed to empowering people throughout the healthcare ecosystem, from specialty clinics to large care networks, from public health to health technology, and everything in between.

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