Processing claims-related transactions through a data clearinghouse comes at a high administrative cost. In fact, healthcare organizations spent about $42 billion in 2021 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.