2025 CAQH Index® Report

The Administrative Workflow

When patients visit a healthcare provider, their journey involves a series of administrative tasks that start with scheduling the appointment and end with payment for the care they receive. These tasks are essential to ensuring care is delivered, but they can also be time-consuming and costly.

The CAQH Index collects detailed information from both providers and health plans on how these administrative tasks are completed. It tracks the methods used, whether fully electronic, partially electronic, or manually, along with the number of transactions processed (volume) and the cost and time required to complete.

By analyzing this data, the CAQH Index highlights inefficiencies in the administrative workflow and identifies opportunities to reduce the time and cost involved. These improvements not only benefit providers by freeing up resources but also ensure patients experience fewer delays in accessing care.

As new technologies automate routine tasks, improve data sharing, and reduce manual work, the CAQH Index is evolving to measure their implementation and impact. By tracking how tools such as AI, FHIR APIs, and ePA are being adopted and used, the Index is becoming a forward-looking benchmark for the modernization of healthcare administration.

* The reporting of Acknowledgements has been retired after achieving consistent 100% electronic adoption. Data is included in total volume for trend analyses.

Note: This diagram illustrates the administrative workflow in its simplest form. In practice, some transactions may occur multiple times or in multiple steps and be triggered by other events. 

Key Findings

Medical Plan Adoption of Fully Electronic Administrative Transactions, 2023-2025 CAQH Index

Dental Plan Adoption of Fully Electronic Administrative Transactions, 2023-2025 CAQH Index

Medical and Dental Industry Estimated National Volume
2023-2025 CAQH Index (in billions)

Medical and Dental Industry Estimated National Spend
2023-2025 CAQH Index (in billions)

Medical and Dental Industry Estimated National Cost Savings Opportunity
2023-2025 CAQH Index (in billions)

Medical Provider Average Cost per Transaction for Electronic and Manual Transactions
2023-2025 CAQH Index

Industry Call to Action

The 2025 CAQH Index reflects a year of recovery and resilience. The 2024 Change Healthcare cyberattack¹⁸ tested the systems that keep healthcare running, and the industry adapted. Providers and payers rerouted transactions and restored automated connections, avoiding $258 billion in administrative costs, a 17 percent increase from the previous year.

That recovery demonstrates what’s possible when the industry works together, turning disruption into progress toward greater automation, stronger data security, and better care for patients.

Now is the time to build on that momentum. By applying the lessons learned, we can accelerate automation, advance interoperability, and strengthen the systems that connect us all.

What the Industry Can Do:

• Strengthen Cybersecurity
  Protecting healthcare data and systems is essential to keeping care uninterrupted. The Change Healthcare cyberattack showed how one incident can ripple across the industry, halting electronic workflows. In response, two-thirds of medical and dental plans and over one-third of providers enhanced or increased security protocols to reduce risk.¹⁹
  
  The need to strengthen redundancy and backup mechanisms was emphasized.^20,21 By maintaining alternate systems and secure copies of information, organizations can recover more quickly and continue delivering reliable care even when primary systems are compromised. Ongoing investment and coordination will help safeguard patients and ensure the healthcare system remains resilient and dependable.
• Advance Interoperability and Demonstrate Value
  Compliance is just the starting point. As the industry transitions to FHIR-based data exchange, real progress means aligning workflows and priorities across providers, payers, and vendors. Nearly one-third of medical plans cited legacy systems and inconsistent standards as top barriers, while all dental plans pointed to resource limitations.* Addressing these challenges will unlock more automation and make data more actionable.
  
  Demonstrating value is just as important. Over two-thirds of medical and dental plans identified peer benchmarks and return on investment (ROI) data as critical for guiding priorities and evaluating impact in 2025.* Clear evidence of ROI helps organizations focus on solutions that deliver measurable benefits, driving adoption even under budget constraints.
• Leverage Artificial Intelligence (AI)
  AI is moving from concept to everyday practice. More than half of plans and one-quarter of providers now use AI, with provider use focused on administrative tasks such as eligibility checks, note-taking, and patient communications. Dental providers are also increasingly using AI for clinical tasks, including interpreting X-rays and lab results. As confidence in AI tools grow, these technologies will further reduce manual work, streamline operations, and allow staff to focus more on patient care.

By continuing to collaborate, the industry can build a healthcare system that’s more connected, data-driven, and efficient. Together, we can use technology to strengthen care and create lasting progress.

* Data represents findings from supplemental Index questions. Additional insights will be released as part of Index Pro in Q2 2026.

Acknowledgments

The following organizations and individuals contributed to the success of the 2024 CAQH Index:

• Participating medical and dental plans and providers for submitting their data and completing follow-up interviews.
• NORC at the University of Chicago for data collection and analytics.
• CAQH Index Advisory Council for their continued guidance and support of the CAQH Index research

Endnotes

Overview

Industry Call to Action: From Insight to Impact

Background

The CAQH Index tracks the industry adoption of electronic administrative transactions over time. It measures industry volume, spend, cost avoided, and the cost savings opportunity associated with switching from conducting partially electronic and manual transactions to using fully electronic transactions. The 2025 CAQH Index is the thirteenth annual report which collects data from medical and dental plans and providers covering more than half of the insured United States population, according to enrollment reports from the AIS Directory of Health Plans and NADP Dental Health Plan Profiles.^1,2

Recruitment

Data Collection

The CAQH Index collected data through a voluntary online survey tool from June to September 2025. A fillable PDF and Excel version of the survey were also offered to participants. Plan and provider data are representative of the 2024 calendar year, January 1 to December 31, 2024. The medical and dental plan surveys collected data on nine administrative transactions. For providers, data was collected for 10 medical and eight dental transactions.

Supplemental Questions

The medical and dental plan survey also included supplemental questions regarding:

• Use of proprietary reports for Acknowledgements.
• Use of artificial intelligence (AI) for administrative and clinical tasks.
• Preparation for the Interoperability and Prior Authorization Final Rule4 — implementation of electronic prior authorization (ePA) (Medical plans only).
• Value of conflict-of-interest data.
• Payer/provider contracting process.

The medical provider survey collected data on eight administrative transactions and two pharmacy transactions, Prescription/Drug Prior Authorization (NCPDP SCRIPT) and Realtime Pharmacy Benefit Prescription Check (NCPDP RTPB) while the dental provider survey included eight administrative transactions.

For medical and dental providers, this year’s survey included supplemental questions regarding:

• Use of proprietary reports for Acknowledgments.
• Average number of Eligibility and Benefit Verification checks per patient per visit.
• Role within the practice (clinical or administrative).
• Use of the NCPDP drug formulary and benefit standard (Medical providers only).
• Use of artificial intelligence (AI) for administrative and clinical tasks.
• Preparation for the Interoperability and Prior Authorization Final Rule5 — implementation of electronic prior authorization (ePA) (Medical plans only).
• Payer/provider contracting process.

Imputations

To ensure that responses were accurate, logic checks were embedded in the online survey tool for plans and providers to check for data reliability and accuracy for all transactions. Logic checks included a request for additional information if estimates were outside specified bounds. For example, in the provider surveys, if electronic times were three minutes or more, participants were asked to provide an explanation of the process. For the 2025 Index, the provider surveys saw increased incidents of low-quality and potentially fraudulent submissions. Quickly detected as a concern, targeted adjustments were made to both the survey process and the dataset to preserve the accuracy and reliability of the results:

• The survey was limited to only accept responses from US-based IP addresses.
• Additional bot detection technology and security-scan monitoring were implemented.
• Cases were flagged as suspicious using a combination of clinic name, contact name, email address, phone number, location, IP address, completion time, and overall number of questions answered with non-missing information. Additionally, cases with unusually high or low transaction volumes relative to number of staff were reviewed. All reviews were conducted both by project staff and through use of Microsoft’s Copilot LLM.
  • Fraudulent cases included:
    • Duplicate names, email addresses, or phone numbers with more than 2 records or other detected issues
    • Near duplicate names, email addresses, or phone numbers (e.g., email addresses with a single changed digit)
    • Irrelevant information in required fields, such as clinics which listed impossible physical addresses instead of contact names
    • Notable hospitals or clinics without other identifying business information
    • Unusually high or low transaction volumes relative to staff size
    • Unusually high staff pay relative to transaction volume
      • All cases with unusual transaction or pay data were contacted for clarification on transactions, and several were determined to be genuine, including the risk of false positive identification was nonzero.
    • Some additional cases with suspicious but not obviously fraudulent data were contacted to confirm clinic details. Any case which did not respond or was unable to provide matching clinical information was removed from the dataset.

Even with logic checks, some responses were insufficient or out of range. When this occurred, NORC followed up with respondents to obtain more information about the relevant transactions. If clinics did not respond or were unable to provide sufficient additional information, values were imputed using the following rules.

• For processing time values, if a respondent provided information that was greater than the median value plus the Interquartile Range multiplied by 2, the processing time was imputed using the median value plus the Interquartile Range multiplied by 2. In cases where partial time was the same as manual time, partial time was imputed.
• For salary values, if a respondent provided information that was greater than the median value plus the Interquartile Range multiplied by 3, the salary time was imputed with the median value plus the Interquartile Range multiplied by 3. In cases where the reported salary was less than the Median-Interquartile Range, the salary was imputed to the Median-Interquartile Range, or $20,000, whichever was lower.
• Medical plans represented 217 million covered lives, or 63 percent of the United States enrolled population. Medical plans accounted for 4 billion claims received and 20 billion transactions annually. In comparison, dental plans represented 118 million covered lives and approximately 40 percent of the enrolled population. Dental plans represented a smaller portion of volume with 205 million claims received and a total of 915 million transactions.

Overview of Fully Electronic Administrative Transactions Studied, 2025 CAQH Index:

Metrics

Results were aggregated to ensure data privacy. Benchmarks were calculated and reported only for transactions where three or more plans participated. The following metrics were reported for each transaction:

Adoption Rate — The degree to which medical and dental plans and providers complete transactions using fully electronic, partially electronic, or manual modes. Adoption rates are calculated using only medical and dental plan reported volumes.

Estimated Volume — The number of fully electronic, partially electronic, and manual administrative transactions reported by medical and dental plans and providers weighted to a national level.

Cost Per Transaction — The labor costs (e.g., salaries, wages, personnel benefits, and related overhead costs) associated with full electronic, partially electronic, and fully manual transaction as reported by medical and dental plans and providers. Costs include the labor time required to conduct the transaction, not the time and cost associated with gathering information for the transaction and follow-up. Costs do not include system costs (e.g., maintaining, building, or buying software or other equipment).

Administrative Spend (Estimated Spend) — The amount that medical and dental plans and providers spend conducting an administrative transaction in total and by modality.

Cost Avoided — The amount that medical and dental plans and providers have saved by not conducting transactions using partially electronic or fully manual modes.

Cost Savings Opportunity — The administrative cost savings that could be achieved by switching the remaining partially electronic and manual transactions to fully electronic transactions.

Time to Conduct — The time required for providers to conduct a fully electronic, partially electronic and fully manual transaction.

Time Savings Opportunity — The time that providers could save by switching partially electronic and manual transactions to fully electronic transactions.

Adoption Rate

The degree to which medical and dental plans and providers complete transactions using fully electronic, partially electronic, or manual modes. Adoption rates are calculated using only medical and dental plan reported volumes. Transaction adoption is classified into three modes:

Fully Electronic — Administrative transactions conducted using a HIPAA-mandated standard, unless otherwise specified.

Partially Electronic — Administrative transactions conducted using web portals and interactive voice response (IVR) systems.

Fully Manual (Manual) — Administrative transactions requiring end-to-end human interaction such as telephone, mail, fax, and email.

For the figures depicting the medical and dental plan adoption rates, adoption rates were calculated by mode as a proportion of the total volume reported by plans and represent the percent distribution of transactions conducted by mode.

Adoption Rate (per mode) = Volume Reported by Plans (per mode) / Total Volume Reported by Plans

The annual percentage point change is computed as the arithmetic difference between percentages.

Provider Weights

Medical and dental provider results are weighted to provide representative estimates of the medical and dental provider populations.

For medical providers, results are estimated based on the size and type of practice as well as specialty of the responding provider. The groups were defined using the American Medical Association (AMA) Benchmark Practice Survey6 and the AAMC Physician Specialty Data Report.⁷ The distribution of providers in the population was determined using active and self-attested MD/DO information contained within CAQH’s Provider Data Portal.⁸ Size and type of practice included: Less than 5 physicians, 5-50+ physicians, and hospitals. Specialty groups included: Generalist, Specialist, Behavioralist, and Hospitalist.

For dental providers, results are estimated based on the provider’s practice size and Dental Support Organization (DSO) affiliation status. The distribution of providers in the population was determined using the American Dental Association (ADA) Survey of Dental Practice.⁹ The distribution of dental providers was split into 3 groups: non-DSO affiliated solo practice, DSO affiliated solo or group practice, and non-DSO affiliated group practice.

The following table shows the percent of the medical provider population represented in each group:

The following table shows the percent of the dental provider population represented in each group:

Provider weights were calculated by dividing the percent of the sample in each group by the percent of the population in each group as defined by the CAQH’s Provider Data Portal and the ADA. Since not all providers submit data for every transaction, provider weights were calculated individually for each transaction.

Provider Weight (per transaction) = Percentage of the Sample in Each Group Reporting the Transaction / Percentage of the Population in Each Group

Estimated Volume

Plan Estimated Volume

The total transaction volume is estimated based on the proportion of covered lives represented by participating medical plans using the AIS Directory of Health Plans or reported enrollment for medical plans, whichever value was higher. For dental plans the plan reported enrollment was used for estimation. To determine the percent of covered lives represented, the total enrollment from the AIS Directory of Health Plans¹⁰ was used for medical plans and the NADP Dental Health Plan Profiles11 for dental plans. The reporting of Acknowledgments has been retired after achieving consistent 100% electronic adoption; data is included in total volume for trend analyses. The extrapolated national volume for each transaction is calculated by mode as follows for both medical and dental plans:

Extrapolated Plan Volume (per modality) = Volume Reported by Plans / Percent of Covered Lives Represented by CAQH Data Contributors

Provider Estimated Volume

Provider volume is calculated first by determining the percentage of each transaction that was conducted by mode (electronic, partial, or manual) for each provider.

Provider Mode Distribution (per transaction) = Provider Reported Volume for Mode (per transaction) * Provider Reported Volume for All Modes (per transaction)

The provider specific mode distribution was then averaged among providers and weighted by the size and specialty groups listed above.

Average Provider Mode Distribution (per transaction) = Average(Provider Weight (per transaction)* Provider Modality Percentage (per transaction))

To account for small provider cell sizes for some transactions by mode, the plan adoption rate per mode is averaged with the weighted average provider mode distribution. This generates a
single estimated percentage by modality for each transaction.

Provider Distribution (per mode per transaction) = Average(Plan Adoption Rate (per mode per transaction), Average Provider Modality Percentage (per transaction))

Given that each transaction for a plan also occurs for a provider, the national estimated plan volume (by mode) is assumed to be same value as the national estimated provider volume (by mode). To determine the provider volume for each mode, the average provider distribution is multiplied by the national estimated provider volume.

Extrapolated Provider Volume (per modality) = Total Plan Estimated Volume for a Given Transaction* Average Modality Percentage

The industry estimated volume for each transaction is the sum of the plan estimated volume and the provider estimated volume for each mode.

Cost Per Transaction

Transaction costs are reported for fully electronic, partially electronic and manual transactions for medical and dental plans and providers when available depending on sample size. For medical and dental plans, the cost per transaction by mode is a weighted average based on the data submitted by participants reporting a valid result using the proportion of their membership enrollment. The calculation requires both the reporting of a valid transaction volume and transaction cost by a survey participant to be included in the weighted average cost.

For medical and dental providers, weighted average costs per transaction by mode were calculated by NORC based on transaction type, average staff time to conduct a transaction and cost per transaction for each mode. The cost calculation followed a multi-step process to calculate weighted costs per transaction for medical and dental providers:

• The time per transaction by mode and reported salary were averaged using the provider weights stated above, which account for both size and specialization of practice.

Time per Transaction (per mode) = Average(Provider Weight (per transaction)* Provider Reported Time per Transaction (per Mode, in minutes))

Average Salary = Average(Provider Weight (per transaction)* Provider Reported Salary)

• The average loaded salary per minute per mode for each provider was created by multiplying the average salary by a specific loading factor to account for benefit and overhead costs and then dividing that number by minutes in a work year (40 hours/week, 52 weeks/year, or 124,800 minutes).

Loaded Average Salary (per mode per provider, in minutes) = Average Salary * Loading Factor / Minutes in Work Year

• The individual provider loaded cost per transaction per mode was calculated by multiplying the average loaded salary per minute for each responding provider with the average time per transaction by mode among all providers.

Loaded cost (per provider per transaction per mode) = Loaded Average Salary per minute (per mode per provider) * Time per Transaction (per mode, in minutes)

• The average cost per transaction was calculated using the individual provider loaded cost per transaction per mode and the provider weights stated above.

Cost per Transaction (per modality) = Average (Loaded cost (per provider per transaction per mode) * Provider Reported Time per Transaction (per Mode))

Estimated Spend, Cost Avoided and Cost Savings Opportunity

Administrative Spend (Estimated Spend)

Administrative spend (estimated spend) is calculated by multiplying the estimated volume per mode by its respective weighted cost per transaction for medical
and dental plans and providers within a transaction. The total spend per transaction is equal to the sum of spend for each mode per transaction.

Estimated Cost Avoided

The estimated cost avoided is the arithmetic difference between the spend if all transactions were conducted manually and the total estimated spend by transaction. The total manual spend per transaction was computed by multiplying the estimated national volume of all modes by the manual cost per transaction.

Estimated Cost Savings Opportunity

The cost savings opportunity for switching from manual to fully electronic transactions is calculated by multiplying the estimated national volume of manual transactions by the cost per transaction difference between fully electronic and manual transactions for each transaction. The cost savings opportunity for switching from partially electronic to fully electronic transactions is calculated by multiplying the estimated national volume of partially electronic transactions by the cost per transaction difference between the fully electronic and partially electronic transactions for each transaction.

Considerations

Some over-counting and under-counting of transaction volume may occur:

• Some transactions may be reported as fully electronic transactions even if they were initially sent as a manual transaction and then converted to a fully electronic transaction by a practice management system. No direct relationships between or among the volumes of transactions should be inferred.
• Some eligibility and benefit verification transactions may never result in a claim submission or claim payment since some practice management systems make periodic eligibility and benefit verification requests that are not connected to patient encounters.
• Some claim submission transactions may not be requests for payment since only a few plans can distinguish claim submissions that are requests for payment from encounter reports versus claim submissions that are only transmissions of medical service information, such as for value-based payments and capitation arrangements.
• Some transactions may not result in a claim payment transaction if there is no payment due from the health plan after adjudication, such as when a patient is meeting the annual deductible.
• Due to availability of data and the ability to report data in the required format, health plan and providers may be unable to report values for all modes. Blank cells may not indicate that a mode is not used to complete a transaction but rather that data in not available.

The results of this report are based on surveys and may be subject to response bias.

The CAQH Index uniquely tracks only direct costs:

• Costs reported include the labor time required to conduct the transaction, not the time and cost associated with gathering information for the transaction and follow-up. System costs are
  excluded from the cost and savings estimates.
• Sample variation may impact some transaction cost trends from year to year.
• Medical and dental provider costs to conduct a transaction reflect only a snapshot in time for the specific group of providers. Sampling factors such as salary increases or declines, learning curve for a new employee to process a transaction and the mix of specialty type may impact the trending of data.
• The ability to report on all transactions exchanged is dependent on accurate reporting practices used by health plans and providers. Due to employment changes and increases in utilization after the pandemic emergency, some health plans and providers may have had new staff gathering and submitting data, increasing data variability.
• The cost calculation methodology calculates each step (salary, time, and unit cost) as separate results on average based on the provider distribution by size and specialty. This is designed to create a modular and replicable process for cost calculation that can be useful to the industry. However, this assumes that the time and unit cost are independent of each other at the provider level. If results were explicitly calculated at the provider group or respondent level, there may be some slight variation in the overall outcome.

Endnotes

Background and Recruitment

Data Collection

Metrics