Benefit verification drives increased administrative spending in dental offices
2024 CAQH Index shows reliance on plan portals makes tasks more complex
Dental spending on administrative processes increased in 2023, as dental providers and staff handled a higher volume of both manual and electronic tasks that cost more to complete.
This is one of the findings of the 2024 edition of the CAQH Index, the only health care industry benchmarking tool that tracks and reports progress on the adoption of electronic administrative transactions and the possible savings associated with making the switch from manual. It is prepared by the Council for Affordable Quality Healthcare, the health care industry alliance better known as CAQH. The 2024 report consists of data from 2023.
The largest increase in administrative spending in the dental industry came from eligibility and benefit verification spending, which increased by 15% to $2.1 billion. Verification checks can be done fully electronically through an automated transaction that is mandated by the Health Insurance Portability and Accountability Act to meet certain standards; partially electronically through a plan portal; or manually by phone, fax, email or mail.
“The American Dental Association is working with other stakeholders to ensure dental data is included and accurately represented in the standardized data set that is shared during the automated electronic transaction process. This collaborative effort may encourage greater adoption of the automated process and provide a reduction in the burdens associated with verification for dentists and their teams," said Mark A. Moats, D.M.D., chair of the ADA Council on Dental Benefit Programs. "Without the inclusion of this accurate dental data, providers indicated in the CAQH Index that they often do not obtain robust enough information through the automated transaction to be reliable. These limitations have led to continued reliance on plan portals for verification, which can be more time consuming and costly for providers and their teams."
The index attributed the dental industry’s eligibility and benefit verification spending increase in part to rising costs associated with conducting these checks via portals. The portals, which are maintained by insurance companies, vary in requirements and formats, making verification more complex, according to the report.
The potential cost savings of switching to automated electronic checks from portals or manual processes increased by 7% to $580 million for the dental industry in 2023.
To read the full 2024 CAQH Index, visit caqh.org.
