The 25-Minute Phone Call

Strip the denial economy down to its smallest unit and you get a phone call: a staff member dials a payer to ask where a claim stands. CAQH, which has measured the cost of healthcare's administrative transactions every year since 2011, timed that call. For medical providers, a claim-status inquiry by phone consumes 25 minutes of staff time — the longest of any administrative task the Index measures, longer than a manual prior authorization.¹

The same question asked electronically — a standard 276/277 transaction — takes an average of 7 minutes, and the reported manual range runs as high as 60.¹The call does not adjudicate anything. It asks the payer's system a question the payer's system has already answered internally.

In 2023, the medical industry spent $11 billion conducting claim-status inquiries — the third-largest share of the administrative spend the Index tracks.¹ Automation has already done most of the work here: by moving status checks to electronic transactions, the medical industry avoids an estimated $29.5 billion a year it would otherwise spend on the phone. The $2.4 billion is what remains — the residue of inquiries still made by phone, fax, mail, and email.¹

Minute for minute, the status call sits at the top of the Index's task list:

Denials multiply the dialing. A claim paid on first pass may never generate a status inquiry at all; a denied claim re-enters the workflow — correction, resubmission, appeal — and each round has a status to chase. The Index notes that 12 percent of medical claims were denied in 2023, and that providers connect rising denial volume to payers' growing use of automated claim review, which "may result in delayed payments and multiple submissions to resolve."¹

The 2025 edition of the Index, published in February 2026, added a direct measurement of who is automating faster: more than 50 percent of health plans use AI tools in administrative workflows, against 25 percent of provider organizations.²The transaction data points the same way. Fully electronic prior authorization — the one transaction where the provider's side of the exchange is hardest to automate — rose four percentage points between the 2023 and 2024 editions, from 31 to 35 percent of medical volume, while providers still reported 24 minutes per manual request and 16 minutes per portal request, the highest portal time of any task.¹

Regulation is now scheduled to force the pace. The CMS Interoperability and Prior Authorization final rule (CMS-0057-F), published February 8, 2024, requires Medicare Advantage organizations, Medicaid and CHIP programs, and marketplace issuers to implement FHIR-based Prior Authorization APIs beginning January 1, 2027; the rule's operational provisions — decision time frames, specific denial reasons, public prior-authorization metrics — generally take effect January 1, 2026.³⁴ The plumbing that would retire the 25-minute call has a federal deadline. Whether small practices are wired into it by then is the open question the adoption gap describes.

None of this is a story of failure. Automation avoided $222 billion in administrative cost in 2023 and $258 billion in 2024, a 17 percent increase in cost avoidance in a single year; medical administrative spend fell 9 percent.¹²What remains — $20 billion by the 2024 edition's count, $21 billion by the 2025 edition's — is the manual residue, and it is not evenly distributed. It pools wherever a transaction still ends with a person on hold: and the tasks that most often end that way, status inquiries and prior authorizations, are the ones denial rework runs on. The system's remaining inefficiency is paid out in 25-minute increments, by whoever is holding the phone.