Guides

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 $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.  

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