Market Overview

Medicaid Can Save More than $4.8 Billion by Moving to Fully Electronic Transactions

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Medicaid Can Save More than $4.8 Billion by Moving to Fully Electronic Transactions

State agencies and health plans covering 44% of all Medicaid enrollees demonstrate commitment to automation, efficient processes through CORE Certification; remaining payers have an opportunity for savings, operational improvements

PR Newswire

WASHINGTON, Aug. 13, 2018 /PRNewswire/ -- CAQH CORE® today announced that state agencies and health plans covering 44 percent of all Medicaid enrollees have achieved some level of CORE Certification. This compares to 78 percent for commercial health plans and 75 percent for Medicare Advantage plans. Medicaid agencies and health plans can save more than $4.8 billion annually by fully adopting CAQH CORE Operating Rules for electronic transactions as verified by certification.

A collaboration of more than 130 public and private entities across the healthcare industry, CAQH CORE develops operating rules that support electronic sharing of administrative data quickly, cost-effectively and securely. There are currently four phases of operating rules, each covering a different set of administrative transactions. CORE Certification is the gold standard for demonstrating market adoption and adherence to operating rules.

"Medicaid payers confront the challenges of administrative costs, productivity and information security through CORE Certification," said Robin J. Thomashauer, President of CAQH. "The benefits to enrollees, taxpayers and government programs from efficient operational processes and electronic transactions are significant."

By adopting all four phases of operating rules for electronic transactions - and verifying through CORE Certification - Medicaid payers can reduce overhead expenses and direct more state and federal tax dollars toward patient care. For example, Medicaid payers in Florida could save $177 million, Illinois could save $294 million and those in California could save $655 million annually. For an analysis of the potential savings in each state, click here.

"Provider organizations that serve a large number of Medicaid enrollees like CHRISTUS find working with CORE-certified Medicaid plans to be far more efficient and predictable," said George Conklin, CAQH CORE Board Member and CIO, CHRISTUS Health. "We strongly urge those Medicaid plans that are not certified to contact CORE and learn about the benefits to their organizations and the people they serve."

Read the list of CORE-certified organizations or interact with our dashboard of CORE-certified Medicaid payers.

Learn how to become CORE certified.

State

Medicaid Potential
Savings

State

Medicaid Potential
Savings

Alabama

$                      5,739,000

Montana

$                    31,303,000

Alaska

$                      1,329,000

Nebraska

$                      5,366,000

Arizona

$                  124,554,000

Nevada

$                    22,715,000

Arkansas

$                    98,436,000

New Hampshire

$                      7,780,000

California

$                  654,889,000

New Jersey

$                    28,850,000

Colorado

$                  127,604,000

New Mexico

$                    72,186,000

Connecticut

$                    92,791,000

New York

$                  571,587,000

Delaware

$                    18,642,000

North Carolina

$                  225,870,000

District of Columbia

$                    23,151,000

North Dakota

$                      2,955,000

Florida

$                  177,127,000

Ohio

$                  243,585,000

Georgia

$                    63,204,000

Oklahoma

$                      7,176,000

Hawaii

$                    31,659,000

Oregon

$                    99,125,000

Idaho

$                    30,358,000

Pennsylvania

$                  220,646,000

Illinois

$                  294,397,000

Rhode Island

$                    24,328,000

Indiana

$                    91,064,000

South Carolina

$                    99,217,000

Iowa

$                    12,162,000

South Dakota

$                    13,335,000

Kansas

$                      4,146,000

Tennessee

$                    12,228,000

Kentucky

$                    88,723,000

Texas

$                  186,943,000

Louisiana

$                    24,084,000

Utah

$                    33,408,000

Maine

$                      1,687,000

Vermont

$                    18,373,000

Maryland

$                  101,062,000

Virginia

$                    64,359,000

Massachusetts

$                  122,474,000

Washington

$                  135,099,000

Michigan

$                  218,561,000

West Virginia

$                    29,029,000

Minnesota

$                  116,273,000

Wisconsin

$                    74,226,000

Mississippi

$                    22,650,000

Wyoming

$                      6,597,000

Missouri

$                    59,921,000

Total All States

$               4,842,973,000


Methodology: Transaction volume and per transaction savings from the 2017 CAQH Index were applied to the number of Medicaid lives per state not covered by a CORE-certified health plan or state fee-for-service program to estimate the annual state savings that could be realized through full CORE Phase I through IV Certification. Annual state savings potential was estimated using state Medicaid enrollment from the "May 2018 Medicaid & CHIP Enrollment Data Highlights" at Medicaid.gov and Medicaid health plan enrollment from "AIS's Directory of Health Plans, July 2018" at AISHealth.com.

 

About CAQH CORE
CAQH CORE is a nonprofit collaboration of over 130 organizations, including health plans, providers, vendors, state and federal government entities, standards development organizations, and other stakeholders across the industry. Through this collaboration, CAQH CORE helps stakeholders uniformly adopt electronic transactions and exchange data efficiently. Since 2005, CAQH CORE has developed and issued four phases of operating rules that support standards, accelerate interoperability and align fee-for-service administrative activities among providers, payers and consumers. In 2015, the CAQH CORE scope expanded to include exchange needs for value-based payment. www.caqhcore.org

 

Cision View original content:http://www.prnewswire.com/news-releases/medicaid-can-save-more-than-4-8-billion-by-moving-to-fully-electronic-transactions-300695831.html

SOURCE CAQH

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