Revenue cycle management vendor Emdeon Corp. in 2008 launched an initiative to collect hard data on the extent to which providers and payers use electronic claims and related financial/administrative transactions. Now, Emdeon is transferring the initiative, called the U.S. Healthcare Efficiency Index, to CAQH, a Washington-based advocacy organization that leads the Committee on Operating Rules program to further standardize HIPAA transactions.

Emdeon, whose business includes operating the nation's largest claims clearinghouse, will contribute data to the index and CAQH will crunch the numbers.  CAQH is recruiting for a director of research and measurement, and will continue to rely on an industry advisory council that Emdeon formed to guide the U.S. Healthcare Efficiency Index. Emdeon now will join the advisory council.

Emdeon used its clearinghouse data in 2008 to initially estimate the use of electronic transactions, and followed up with a 2010 report that included data from 113 payers. CAQH, which includes insurers, will work to expand payer participation and over time also will target provider participation, says Robin Thomashauer, executive director.

Emdeon by late 2010 was building relationships with payer association AHIP and the Blue Cross and Blue Shield Association to increase payer participation in the index. However, its status as a for-profit and competitive vendor was limiting its ability to further grow the initiative and receive grant funding, says Mariam Paramore, senior vice president of clinical and government services at Emdeon.

CAQH, a not-for-profit neutral party, already was engaged in the CORE initiative and has access to grant funding, Paramore says. The operating rules--mandated in the Accountable Care Act--were picking up stream and the index needed a home that would facilitate independent research, she adds. "It seemed that being home at CAQH, the index had the best opportunity to thrive."

In the 2010 U.S. Healthcare Efficiency Index report, based on 2009 data, Emdeon pegged the electronic claims submission rate at 85 percent. Other electronic transactions measured included eligibility verification (40 percent), claims status (40 percent), claim payment (10 percent) and remittance advice (46 percent.) More information is available at ushealthcareindex.com.

 

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