CAQH Index Finds $20 Billion in Cost Savings Opportunities

The 2025 CAQH Index found that more than $20 billion in cost savings could be achieved with more adoption of automatic and electronic workflows in the US,¹ demonstrating the tangible benefits to reducing manual processes, when possible, in both the medical and dental industries.

The 2025 CAQH Index incorporates data from 600 provider organizations and health plans that represent 63% of all insured lives, with participation and support coming from America’s Health Insurance Plans, the American Medical Association, and the American Hospital Association, among others. The Index is free to access for all and covers the adoption of automated processes in 2024 and the potential for cost savings through the end of that year.

The Index primarily collects administrative data from providers and health plans. Whether a task is completed through manual, partially electronic, or fully electronic processes is considered, as well as how many transactions are processed with the time and cost that it takes to complete the task. Artificial intelligence (AI), electronic prior authorization (ePA), and FHIR APIs were tracked to see how they were being adopted and used to evaluate how health care is progressing.

Results published as part of the Index found that adoption of medical electronics remained stable in this index. This trend follows the 2024 Index, when a gain in adoption was seen overall. Medical prior authorization in particular saw an increase in electronic adoption, increasing from 31% in the 2023 Index to 40% in the 2025 Index. Medical Claim Status Inquiry and Claim Payment also increased over time, with 74% and 73% adoption in the 2023 Index, respectively, which increased to 81% and 78%.

Attachments decreased in adoption across both medical and dental practices, decreasing from 32% and 37% in the 2024 Index, respectively, to 24% and 28%. Dental practices also saw an increase in claim payment adoption from 21% in the 2023 Index to 33% in the 2025 Index. Electronics adoption remained stable across all other categories, including claim submission, coordination of benefits, and remittance advice.

The overall increase in medical transaction volume was 10%, and dental transaction volume saw a 6% increase, which was moderate growth compared with previous years. CAQH concluded that moderate transaction growth “signals that providers kept care and payments moving, even while relying on manual workarounds.” This, they wrote, would come at a cost of administrative burden, raise the risk of errors, and slow reimbursement.

Efficiency and cost management did improve across the board, as medical spending decreased by 9% and dental spending decreased by 4%, totaling approximately $81.9 billion in savings. This decrease in spending indicates that there was less financial strain on the providers, and patient care did not experience any significant resource disruption. Even with the spending savings, CAQH estimates that the medical industry could save $18.7 billion by automating more, up 2% from last year’s Index. This was due primarily to the increased cost of some manual processes. Overall, the potential for medical savings has increased from $16.4 billion in the 2023 Index to $18.7 in the 2025 Index, indicating a continued need to focus efforts on saving in these areas.

The dental industry saw a decrease in cost-saving opportunities, with the potential to save up to $1.9 billion, a 10% decrease from last year. The overall saving opportunity was decreased due to lower transaction costs.

The results should be taken within the context of the Change Healthcare ransomware attack, which occurred in February of 2024 and affected approximately 193 million individuals across the US. This ransomware attack affected automated payment systems and the clearinghouse, which steered health care professionals toward manual processes before the restoration of the automated system, including submitting claims, prior authorizations, and payment requests manually. This outage could have affected the results found in the Index.

CAQH outlined areas that the industry can focus on in the future to cut costs and streamline processes. Specifically, the industry can strengthen cybersecurity to keep care uninterrupted; advance interoperability between providers, payers, and vendors; and leverage AI for notetaking, patient communication, and eligibility checks. According to the AMA, about 2 in 3 physicians are using augmented intelligence as of February 2025, which was up 78% from 2023.² Continued trends in this direction could help to save time for clinicians and simplify processes for patient care.

“As technologies evolve, from FHIR-based exchange to AI tools, the Index provides insight into how innovation influences the administrative experience,” said Sarah Ahmad, CEO of CAQH.¹ “With a shared commitment to efficient systems, we can help ensure that patients and providers feel the benefit.”

References

1. 2025 CAQH Index Report: Executive Report. CAQH. Accessed April 28, 2026. https://index.caqh.org/hubfs/2025-26_Index_Dashboard/AskTheIndex_KnowledgeBase/2025%20CAQH%20Index%20Report%20Executive%20Report.pdf
2. Henry TA. 2 in 3 physicians are using health AI—up 78% from 2023. American Medical Association. February 26, 2025. Accessed April 28, 2026. https://www.ama-assn.org/practice-management/digital-health/2-3-physicians-are-using-health-ai-78-2023