Saving billions with more automation | ViVE 2026

Los Angeles - Some healthcare transactions are almost always submitted electronically.

Nearly all claim submissions (98%) and checks to verify benefits (96%) take place electronically, according to the latest CAQH Index.

Erin Weber, chief policy and research officer of CAQH (the Council for Affordable Quality Healthcare) wants to see those numbers get to 100%. In an interview at the ViVE digital health conference, she says those few percentage points actually amount to billions of dollars.

Overall, CAQH projects that submitting all healthcare transactions electronically would save the industry about $21 billion.

Weber tells Chief Healthcare Executive® that submitting all eligibility verifications automatically would generate about $10 billion in savings.

“It's about half of the industry's total cost savings opportunity,” Weber says.

Those few percentage points obscure the massive volume of transactions to determine a patient’s benefits and eligibility. Billions of those transactions take place each year.

“On average, there’s about three to four eligibility inquiries for each patient encounter,” Weber says.

Electronically filing each claim submission would generate an additional $3 billion in savings, Weber notes.

Healthcare organizations have made steady progress in handling more transactions electronically, saving an estimated $258 billion in administrative costs in 2024, according to the CAQH report.

Health systems made progress even with the disruption of the Change Healthcare cyberattack, the most disruptive cyberattack the U.S. healthcare industry has ever seen.

About 190 million Americans were impacted by the Change Healthcare breach, and most hospitals and health systems experienced disruptions. Many had to file transactions manually due to the breach.

Weber says she’s encouraged by the resilience of the industry in moving claims electronically, even in the face of such an unprecedented event.

“The interesting thing about the data from this year's index shows that the industry really did recover,” Weber says. “So we didn't make as much progress as we've been looking towards automating transactions, but we didn't lose ground in the way that it seems like we might have.”

But there’s one healthcare transaction that lags others when it comes to automation: prior authorization, the process of filing claims to health insurance companies to get approval for treatment plans, medication and surgical procedures.

Only 40% of prior authorization transactions were handled electronically in 2024, according to the CAQH Index.

"It's been a challenge for a long time,” Weber says of the push to submit more claims electronically.

Still, it actually represents a solid uptick from 2023, when 35% of pre-approval requests were done electronically. Weber calls an increase of 5 percentage points “significant progress.”

“I thought 5% was actually a positive sign that the industry is continuing to progress,” Weber says.

In 2022, only 31% of prior authorization transactions were submitted electronically.

She says the cost savings opportunity for fully automating prior authorization is $50 million to $60 million, far less than automating benefit verification and submitting claims. And as Weber says, “You don’t have a prior authorization for every encounter.”

Still, hospitals and doctors have long bemoaned prior authorization, saying the process delays patients from getting the care they need and contributes to staff burnout.

“Certainly, the patient impact of speeding up and automating prior authorization is really significant,” Weber says.

Weber says she understands concerns about some healthcare organizations being left behind as more health systems shift to AI. But she is also optimistic about the benefits being widely available.

“I think there's a lot of promise in terms of being able to lower the cost of some of these digital health tools,” she says.

For organizations that are lagging behind in their digital transformation, Weber advises to look closely at the potential return on investment as they evaluate tools. She notes that some nonprofit groups can help evaluate AI solutions.

“Finding a way to make that business case to your leaders is really important,” Weber says.