CAQH Measures COVID-19 Impact on Healthcare Transaction Volumes

How has COVID-19 impacted administrative transactions? 

In May 2021, CAQH Explorations released an issue brief examining the impact of COVID-19 on transaction volumes. The initial results indicated that most administrative transactions experienced a decline in volume during the early months of the pandemic (January – May 2020) compared to the same timeframe in 2019.

The reductions in transaction volume can in large part be attributed to changes in pandemic resource allocation and state and local policy changes intended to contain the spread of COVID-19. For example, to ensure that patients quickly received the care they needed, several health plans waived requirements for prior authorization. As a result, prior authorization experienced the steepest decline in transaction volume at -27%.

Patients were trying to limit their virus exposure, and many chose to defer medical appointments and treatments. In addition, in March 2020, the Centers for Medicare and Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the pandemic. As a result, both claim submission (-9%) and claim status inquiry (-12%) experienced declines in volume as patients and providers modified their behaviors to follow new guidelines surrounding COVID-19.

Despite this reduction in overall healthcare utilization, changes in telemedicine policy enabled many patients to access medical services from home. With this expansion, providers continued to verify a patient’s eligibility and benefits to determine if they were eligible for telemedicine visits, so the volume of eligibility and benefit verification remained unchanged during this period.

What comes next? 

While administrative transaction volume is expected to increase over time, health plans and providers are grappling with the immediate impact of COVID-19 on the business of healthcare and the unknown long-term effects. CAQH Explorations continues to monitor these trends and is now collecting data for the 2021 CAQH Index, which will examine transaction volumes for all of 2020. To learn more about participating in the 2021 CAQH Index, please reach out to explorations@caqh.org.