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Study Results Show CAQH CORE Certification Dramatically Cuts Administrative Costs, Accelerates I.T. Adoption by Providers and Health Plans
Date:6/2/2009

proximately seven minutes less than telephone verifications, saving providers $2.10 per verification. There are more than 1 billion claims verified for eligibility each year in the U.S.
  • Providers working with CORE-certified health plans saw 10-12% fewer claims denials, resulting in improved practice payment.
  • Providers working with CORE-certified health plans saw a 20% increase of patients verified prior to a visit, significantly reducing administrative burden at the point of care.
  • Health plans that became CORE-certified had a payback in less than 12 months. For example, by switching from telephone to real-time electronic claims verification, the average annual reduction in administrative costs can be more than $2.5 million per plan.

  • "CORE is invaluable for reducing the paper chase and telephone tag that has plagued our industry for far too long," said Joel Perlman, CFO, EVP Finance of Montefiore Medical Center in New York. "Having this national solution will make it easier for everyone to perform real-time electronic transactions, and devote more resources to patient care."

    "The study shows that when a health I.T. solution like CORE benefits both providers and health plans, adoption of electronic data interchange accelerates and ROI increases. This scenario advances the goals of the American Reinvestment and Recovery Act, including the need to lower overall healthcare costs and improve the quality of care," said Barbara Archbold, Healthcare Sales and Solutions Leader for IBM's Global Business Services. "Meeting such goals becomes easier and more attractive when everyone in the industry is playing by the same rules."

    A synopsis of results from the CAQH CORE study is available at www.coreconnect.org.

    About CORE

    CORE is a collaboration
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