Administrative Transaction Costs by Provider Specialty

This technical report presents findings from the 2023 CAQH Index regarding administrative transaction costs across different provider specialties in the medical industry. The report identifies the significant administrative burden faced by providers, particularly in revenue cycle activities such as verifying patient eligibility and submitting claims. It highlights that the medical industry incurs approximately $83 billion annually on administrative tasks, with a substantial portion attributed to provider transactions. The analysis reveals that generalists tend to have lower transaction costs compared to specialists and behavioralists, primarily due to the complexity of services provided by the latter groups. The report details various administrative processes, including eligibility verification, prior authorization, claim submission, and claim status inquiry, and discusses the potential for cost savings through the adoption of electronic transaction standards. The findings emphasize the need for targeted efforts to reduce administrative burdens and improve efficiency in provider practices.