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

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CAQH

Aug 13, 2018, 06:00 ET

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

SOURCE CAQH