Healthcare automation is growing across claims, prior authorization, hospital scheduling, billing, and revenue cycle management. The available figures show substantial savings opportunities, rapid growth in electronic transactions, and widespread predictive-AI use among non-federal acute care hospitals. They also show that adoption is uneven: some workflows are close to fully electronic while others remain largely manual.
Table of contents
- Administrative spending and savings
- Electronic transactions by workflow
- Prior authorization remains a major opportunity
- Claims automation and submission trends
- Predictive AI in hospitals
- Workforce pressure and clinical automation
- Revenue cycle outsourcing
Administrative spending and savings
The 2024 CAQH Index reported that automation helped the healthcare industry avoid $222 billion in administrative spending in 2023. That was a 15% increase from the prior year. The same index identified a further $20 billion opportunity for the medical and dental industries combined if remaining manual work moved to automated workflows.
The opportunity was not evenly divided between the two industries. The medical industry’s cost savings opportunity was $18.4 billion, up 12% year over year. The dental industry’s opportunity was $2.1 billion, up 11% year over year. These are reported opportunities, not guaranteed savings or forecasts of realized future reductions.
Medical administrative spending remained essentially flat at $83 billion in 2024, rising by less than 1%, according to the 2024 CAQH Index. Dental administrative spending moved differently: it increased 10% to $6.9 billion. The contrast suggests that higher automation activity does not automatically produce the same spending pattern across healthcare segments.
Transaction growth also differed by setting. Electronic transaction volume increased 15% in medical workflows and 33% in dental workflows. Overall medical transaction volume increased 13%, while overall dental transaction volume increased 20%. The 2024 CAQH Index therefore describes a market in which activity is expanding while organizations continue to look for savings from digitizing the manual portion.
The largest increase in medical administrative spending was claim payment, at 13%. In dental administration, the largest increase was eligibility and benefit verification, at 15%. These categories point to specific areas where transaction scale and automation capability matter most.
Electronic transactions by workflow
Adoption rates in the 2024 CAQH Index varied sharply by transaction type. Medical remittance advice reached 90% adoption, and medical claim payment reached 89%. Medical coordination of benefits reached 80%, while medical claim status inquiry reached 77%. Medical claim submission was much lower at 37% in that index.
Dental adoption showed a different pattern. Dental claim submission reached 98%, the highest rate among the listed dental workflows. Dental claim payment reached 39%, dental remittance advice reached 36%, dental claim status inquiry reached 30%, and dental coordination of benefits reached 28%.
| Workflow | Medical adoption | Dental adoption |
|---|---|---|
| Claim submission | 37% | 98% |
| Claim payment | 89% | 39% |
| Remittance advice | 90% | 36% |
| Claim status inquiry | 77% | 30% |
| Coordination of benefits | 80% | 28% |
The comparison is descriptive rather than a direct ranking of the industries. The medical and dental percentages refer to different workflow environments, and the 2024 CAQH Index reports them as adoption measures for their respective sectors. Still, the spread is useful: claim submission was highly automated in dental workflows but was reported at a substantially lower level for medical workflows, while the reverse pattern appeared in several downstream medical transactions.
The CAQH Index also said that new CMS HL7 FHIR-based API requirements by 2027 create an opportunity to simplify prior authorization. That statement identifies a future implementation opportunity; it does not quantify how much adoption or savings the requirements will produce.
Prior authorization remains a major opportunity
Prior authorization was one of the clearest examples of uneven healthcare automation in the CAQH figures. In the 2024 CAQH Index’s reporting of the prior-year results, prior authorization accounted for a 23% increase in overall volume from the previous year, while electronic prior authorization volume increased 61%. The medical industry spent 30% more on prior authorization than the prior year, an increase of $1.3 billion.
The process also consumed different amounts of provider time depending on the channel. Providers spent an average of 11 minutes conducting prior authorization electronically and 16 minutes conducting it through a portal. The CAQH Index estimated $494 million in annual cost savings from full electronic prior authorization in the medical industry. It placed the provider unit cost for prior authorization using the HIPAA standard at approximately $6 per transaction.
Medical prior authorization adoption in 2023 was 31% fully electronic, 32% partially electronic, and 37% fully manual. Those three figures describe the distribution of reported adoption states for that year. The 37% fully manual share helps explain why a growing electronic volume could coexist with a large remaining savings opportunity.
The measures also need a clear time reference. The prior authorization figures in this section are from the 2023 CAQH Index results as identified in the 2024 CAQH reporting, and the adoption percentages specifically describe 2023. They should not be read as current adoption rates for a later year.
Claims automation and submission trends
Claim submission provides a useful contrast with prior authorization. In the 2023 CAQH Index, medical claim submission adoption reached 98% fully electronic, while dental claim submission adoption reached 87% fully electronic. Medical claim submissions rose 8% in 2023, and dental claim submissions rose 3%.
Higher electronic adoption did not mean that claim-submission spending was static. Medical claim submission spending rose 67% to $19 billion in 2023. Dental claim submission spending rose 34% to $1.3 billion. These spending figures describe the reported cost of the submission activity, not the amount saved by automation.
The cost-saving opportunity moved in opposite directions. In 2023, the medical claim submission cost savings opportunity decreased 8% as the industry approached full adoption of the electronic standard. The dental claim submission cost savings opportunity increased 4%. The paired results suggest that remaining opportunity depends on both transaction volume and how much manual work remains, rather than on electronic adoption alone.
Taken together with the 2024 CAQH adoption figures, the claim data illustrates why a single “automation rate” can be misleading. A workflow can have high electronic submission adoption while other activities, such as payment, status inquiry, or coordination of benefits, retain different adoption levels. Administrative automation is a collection of processes rather than one uniform capability.
Predictive AI in hospitals
The 2024 ASTP Data Brief No. 80 found that 71% of non-federal acute care hospitals used predictive AI in 2024. The figures cover hospital use of predictive AI, including administrative applications, rather than all forms of healthcare automation.
Among hospitals using EHR-developed AI, 58% used predictive AI for simplifying or automating billing. Among hospitals using other AI sources, the corresponding share was 73%. Scheduling showed a narrower difference: 67% of hospitals using EHR-developed AI used predictive AI for scheduling, compared with 65% among hospitals using other AI sources.
| Predictive-AI use case in 2024 | EHR-developed AI | Other AI sources |
|---|---|---|
| Simplifying or automating billing | 58% | 73% |
| Scheduling | 67% | 65% |
The ASTP data also measured evaluation and oversight. In 2024, 82% of hospitals evaluated predictive AI for model accuracy, and 74% evaluated it for model bias. A total of 79% conducted post-implementation evaluation or monitoring. In addition, 74% said multiple entities were accountable for evaluating predictive AI.
These figures describe reported hospital practices, not a guarantee that every deployed model performs accurately or without bias. They show that evaluation and monitoring were common components of predictive-AI implementation among the hospitals covered by the brief.
Workforce pressure and clinical automation
The Philips Future Health Index 2024 connected automation with staffing pressure. It found that 92% of healthcare leaders said automating repetitive tasks or processes was critical for addressing staff shortages. At the same time, 65% said healthcare professionals were skeptical of automation. The results show simultaneous pressure to automate and concern about how automation will be received.
Among the surveyed leaders, 41% planned to implement automation for workflow prioritization. Also, 89% already saw virtual care helping to ease staffing shortages, and 85% were currently investing in or planning to invest in generative AI. These figures describe leaders’ reported views and plans in the Philips survey, not measured outcomes across all healthcare organizations.
Philips’ cardiology-focused 2024 Future Health Index provided additional context. More than 80% of surveyed leaders said their organization was already using AI for clinical decision support or planning to use it within three years for remote patient monitoring. The survey also found that 93% had data integration challenges affecting timely, high-quality care.
Within that cardiology-focused survey, 46% cited unnecessary repeat tests or scans caused by data inefficiencies as the top reason for those data integration challenges. Automation was viewed positively as a response: 91% said it would save time by reducing day-to-day administrative tasks, and 93% said it would help mitigate staff shortages.
The cardiology results are narrower than the general Future Health Index findings because they focus on that clinical area. They therefore provide a specialty-specific view of how leaders connect automation, data integration, repeat work, and staffing.
Revenue cycle outsourcing
Automation also intersects with decisions about external revenue cycle support. In HFMA’s 2024 Revenue Cycle Management survey, 74.2% of respondents said they currently used vendors for revenue cycle outsourcing. Among outsourcing users, 45.8% were somewhat satisfied with their partnerships and 25.0% were very satisfied.
The survey also measured partner stability. A total of 60.6% of outsourcing users had no plans to switch outsourcing partners in the next 12 months. Meanwhile, 30.9% planned to evaluate or switch the back-end outsourcing partner during that period.
These numbers should not be treated as a direct measure of automation adoption. Outsourcing can include technology, people, or combined services, and the HFMA survey figures concern vendor relationships. They are nevertheless relevant to healthcare automation because revenue cycle operations are one of the administrative areas where organizations may combine internal workflows, electronic transactions, software, and external support.
Across the available measures, the pattern is consistent: healthcare automation is established in several high-volume transactions and expanding into AI-supported billing, scheduling, and clinical operations, while prior authorization, data integration, and other manual workflows continue to represent significant operational and cost-saving opportunities.