Electronic Transaction Adoption Rates

CAQH CORE is the organization overseeing the adoption of HIPAA transactions as part of the ACA mandated adoption of these transactions. During 2013, the eligibility transaction (270/271) and the claim status transaction (276/277) became mandated for use by all HIPAA eligible entities. At the beginning of 2014, rules pertaining to EFT and the 835 electronic remittance came into effect.

CAQH CORE has reported the adoption rates for electronic transactions as of the end of 2013. These numbers represent the percentage of these transactions that are conducted electronically of the total of all transactions of these transaction types.

Transaction      Adoption Rate
Claims Submission 91%
Eligibility Verification 81%
Claim Status Inquiry 72%
Claim Payments 56%
Remittance Advice 53%
Prior Authorization 15%

These figures were calculated based on data provided by health plans covering about 40% of the covered lives in the U.S. For more information on this data and the compliance process, visit the CAQH CORE web site, www.caqh.org .

caqh chart

By Kalon Mitchell – President, MEDTranDirect

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