Healthcare EFT Statistics 2026
By Axis Intelligence Research
Co-author: Sarah Davis | Last updated: August 24, 2026 | License: CC BY 4.0
US health insurers sent medical and dental providers 547.66 million healthcare EFT claim payments worth $2.94 trillion in 2025. According to Axis Intelligence Research, that single segment moved 3.16% of all ACH Network dollars on 1.56% of its payments, and its year-over-year growth then collapsed to 2.3% in the second quarter of 2026.
Quick Answer
Healthcare EFT claim payments on the ACH Network reached 547.66 million payments worth $2.94 trillion in 2025, up 7.3% in volume and 10.9% in value (Nacha). Medical practices have adopted EFT for 78% of claim payments against 33% for dental (2025 CAQH Index). According to Axis Intelligence Research, the EFT Settlement Share (EFTS) stood at 71.8% for 2024 — meaning roughly 72 cents of every dollar US health plans paid out settled through the ACH Network.
Key Findings
- According to Nacha figures published January 14, 2026, medical and dental providers received 547.66 million healthcare EFT claim payments in 2025, worth $2.94 trillion — increases of 7.3% and 10.9% over 2024.
- According to Axis Intelligence Research, the EFT Settlement Share reached 71.8% in 2024: $2.651 trillion in ACH healthcare claim payments against $3.694 trillion in private health insurance, Medicare and Medicaid spending reported by CMS.
- According to Axis Intelligence Research, the Claim Payment Modernization Index reads 121.7 for the 2024 data vintage against a 2022 baseline of 100, with dental adoption contributing more of the gain than payment volume.
- Healthcare EFT volume growth fell to 2.3% in the second quarter of 2026 — 141.4 million payments — the slowest quarterly rate Nacha has published in this segment since it began breaking it out in quarterly infographics.
- According to Axis Intelligence Research, the average healthcare EFT claim payment was worth $5,368 in 2025, slightly more than double the $2,643 average across the whole ACH Network.
How Many Healthcare EFT Claim Payments Were Made in 2025?
Insurers sent 547.66 million healthcare EFT claim payments worth $2.94 trillion through the ACH Network in 2025, per Nacha’s ACH Network Volume and Value Statistics. Volume rose 7.3% and value rose 10.9%.
The long arc is the part payers quote. Nacha counted 149 million healthcare claim payments in 2014, so eleven years produced a 267.6% increase in payment count. Value climbed 234% over the same span, from an implied $880 billion.
ACH Healthcare EFT Claim Payments, 2022–2025
| Year | Payments (millions) | Value ($ trillions) | Volume change | Source |
|---|---|---|---|---|
| 2022 | 453.1 | — | +6.3% | Nacha, Axis calculated |
| 2023 | 488.0 | — | +7.7% | Nacha |
| 2024 | 510.0 | 2.651 | +4.5% | Nacha, Axis calculated |
| 2025 | 547.66 | 2.940 | +7.4% | Nacha |
Sources: Nacha ACH Network Volume and Value Statistics and Nacha healthcare EFT releases dated January 10, 2024, February 4, 2025 and January 14, 2026, retrieved August 24, 2026. The 2022 count and the 2024 value are Axis Intelligence Research derivations, disclosed in Methodology.
A discrepancy we are not going to reconcile quietly. Nacha’s February 2025 note put 2024 growth at 4.6%; a separate Nacha item the same month put it at 4.3%. The published annual counts themselves — 488 million and 510 million — imply 4.5%. Three figures, one transition, all from the same organization. The gap is rounding in the headline counts rather than a data error, and it matters only because a 0.3-point spread on a base of half a billion payments is about 1.5 million claim payments. Anyone citing a precise healthcare EFT growth rate for 2024 should say which Nacha document they took it from.
Quarterly Volume: the Deceleration Nobody Has Flagged
| Quarter | Payments | Year-over-year change | Source |
|---|---|---|---|
| Q1 2025 | 125 million | +8.1% | Nacha |
| Q3 2025 | ~140 million | +6.8% | Nacha |
| Q2 2026 | 141.4 million | +2.3% | Nacha |
Sources: Nacha Q1 2025 results (April 23, 2025); Nacha commentary on Q3 2025 (October 14, 2025); Nacha 2Q26 ACH Network infographic (July 30, 2026). Nacha publishes segment counts in the quarterly infographic rather than the press release, and does not publish a continuous quarterly healthcare series; quarters not confirmed against a Nacha-hosted document during this session are omitted rather than filled in.
Working back from the 2.3% figure, Axis Intelligence Research puts second-quarter 2025 healthcare volume at 138.2 million. So the segment added roughly 3.2 million payments year over year in a quarter where B2B added about 200 million and Same Day ACH added about 99 million. Healthcare EFT is no longer keeping pace with the network it rides on.
Sarah Davis: Read the two rates together and the story writes itself. Volume growth is stalling while value growth stays in double digits, which is what a saturating rail looks like when the remaining conversions are small offices with small claim payments. The easy wins — national plans, hospital systems, large multi-site groups — enrolled years ago. What is left is a long tail of practices where the take rate on switching is a staff-hours problem, not a treasury problem, and staff hours are exactly what nobody in a four-chair dental office has.
Source: Axis Intelligence Research — CC BY 4.0
What Share of US Health Insurer Payouts Settles as EFT?
Nobody publishes this ratio, so Axis Intelligence Research built it.
EFTS — EFT Settlement Share
EFTS = (ACH healthcare claim payment value) ÷ (private health insurance + Medicare + Medicaid spending), same calendar year.
| Input | Value ($ billions) | Source |
|---|---|---|
| ACH healthcare claim payment value, 2024 | 2,651.0 | Nacha, Axis calculated |
| Private health insurance spending, 2024 | 1,644.6 | CMS |
| Medicare spending, 2024 | 1,118.0 | CMS |
| Medicaid spending, 2024 | 931.7 | CMS |
| Denominator | 3,694.3 | CMS |
| EFTS, 2024 | 71.76% | Axis Intelligence Research |
Payer spending inputs come from the CMS National Health Expenditure Fact Sheet, retrieved August 24, 2026. Ratio computed by Axis Intelligence Research.
According to Axis Intelligence Research, roughly 72 cents of every dollar that US health plans paid out in 2024 settled as an ACH healthcare EFT. Against total national health expenditure of $5.279 trillion — a figure that includes out-of-pocket payments, public health activity and administration, none of which move as claim payments — the same numerator represents 50.2%.
Scope: EFTS measures settlement channel, not claim accuracy or timeliness, and the numerator counts dollars leaving the ACH Network toward providers rather than dollars a provider ultimately keeps. The denominator is program spending, which includes plan administration alongside benefits paid.
One ratio we refused to publish. Dividing Nacha’s 2025 healthcare value ($2.94 trillion) by the 2024 CMS denominator yields 79.6%, and that number will circulate if we print it. It is meaningless: the numerator is a calendar year ahead of the denominator during a period when payer spending grew 7.2%. CMS has not released 2025 National Health Expenditure detail, so a matched-year 2025 EFTS does not yet exist. The 2024 reading is the one that survives scrutiny.
How Widely Have Providers Adopted EFT Claim Payments?
Volume tells you how much moved. Adoption tells you how much did not.
The 2025 CAQH Index, released February 19, 2026 and covering 2024 activity, puts medical claim payment EFT adoption at 78% and dental at 33%. Dental climbed from 30% a year earlier, more than double its 2021 reading, and still leaves two dental claim payments in three arriving as something other than an EFT. The Index is built on data from more than 600 provider organizations and health plans representing 63% of insured lives, which makes it the widest sample in the field and also the reason its counts do not line up with an operator’s.
| Segment | EFT claim payment adoption, 2024 data | Prior reading | Source |
|---|---|---|---|
| Medical | 78% | 73% (2022 data) | CAQH Index |
| Dental | 33% | 21% (2022 data) | CAQH Index |
Source: 2025 CAQH Index and 2023 CAQH Index, as reported by CAQH and by Nacha, March 16, 2026. CAQH now operates under the DataSpring brand; the Index name is unchanged.
Two details inside the 2025 Index deserve more attention than the headline adoption rates. Paper check use for medical claim payments fell more than 8% in the year. And medical claim payment volume itself dropped by roughly 50 million transactions, which means the 78% adoption rate improved partly because the denominator shrank. Adoption rates are ratios, and ratios move for two reasons.
CAQH also prices the remaining gap: $246 million in annual savings if dental practices moved entirely to EFT, inside a $21 billion total opportunity from full automation of manual and partially manual administrative transactions across the industry. Nacha’s own framing of the residual leans on check fraud rather than cost, citing the 2025 AFP Payments Fraud and Control Survey finding that 63% of respondents experienced actual or attempted check fraud in 2024 — an exposure profile our Data Breach Tracker logs from the other direction.
The Count Gap Between the Two Standard Sources
Here is a tension no one in this niche publishes. Nacha counted 510 million ACH healthcare claim payments in 2024 across medical and dental combined. Nacha’s own March 2026 summary of the 2025 CAQH Index reports 309 million EFT claim payments for 2024, up 11.2% — and does not state in that sentence whether the figure is dental only or all-payer, though the preceding year’s comparator of 278 million dental EFT payments implies dental.
Both readings are uncomfortable. If 309 million is dental, dental would be 61% of all healthcare ACH claim payments while sitting at a 33% adoption rate. If it is the all-payer total, it undercounts Nacha’s operator figure by 201 million payments. Axis Intelligence Research is not choosing between them. The two organizations count different objects — CAQH extrapolates transaction counts from a plan and provider panel, Nacha counts settled ACH entries — and until one of them publishes a reconciliation, any article presenting a single authoritative count of US EFT claim payments is picking a source and hoping.
Sarah Davis: The adoption gap is a fee story wearing a technology costume. Dental plans lean harder on virtual credit cards than medical plans do, and a VCC is a claim payment that arrives already shrunk by an interchange-style fee the practice never negotiated. A dentist who accepts one is paying to be paid. The reason dental adoption doubled in three years is not that dentists discovered banking; it is that state legislatures started making the fee-free default mandatory.
What Is the Claim Payment Modernization Index?
Volume growth alone cannot say whether healthcare payment is modernizing or just tracking claim counts. So Axis Intelligence Research built one reading that combines what moved with who switched.
CPMI — Claim Payment Modernization Index
A composite of three sourced components, each indexed to its 2022 value = 100, then weighted:
| Component | Weight | 2022 data vintage | 2024 data vintage | Component index |
|---|---|---|---|---|
| ACH healthcare claim payment volume | 40% | 453.1 million | 510.0 million | 112.6 |
| Medical EFT claim payment adoption | 35% | 73% | 78% | 106.8 |
| Dental EFT claim payment adoption | 25% | 21% | 33% | 157.1 |
| CPMI reading | 100.0 | 121.7 |
Formula: CPMI = 0.40 × (ACH_vol ÷ ACH_vol_2022 × 100) + 0.35 × (medical_adoption ÷ medical_adoption_2022 × 100) + 0.25 × (dental_adoption ÷ dental_adoption_2022 × 100).
Baseline: 2022 = 100. This is the baseline pairing, not a re-based history — the components align to CAQH Index data vintages, and the intervening vintage lacks a published medical adoption figure precise enough to index, so no 2023 reading is asserted.
Weights, and why: ACH volume carries the largest single weight because it is the only component measured from settled transactions rather than a survey panel. Medical adoption is weighted above dental because medical claim payments dominate the dollars. Dental carries 25% despite its small share of value because it is where the remaining conversion actually sits — an index that under-weighted it would read as flat while the industry’s real change was happening.
Cite this metric as: Axis Intelligence Research, Claim Payment Modernization Index, 2024 data vintage reading, published August 24, 2026. CC BY 4.0.
Decomposed, the reading is more interesting than the headline. Dental adoption contributes 39.3 of the 121.7 points on a 25% weight, while ACH volume contributes 45.0 on a 40% weight. The modernization signal in healthcare payments over these two years came disproportionately from the smallest, least-automated corner of the industry.
How Big Is a Healthcare EFT Payment?
According to Axis Intelligence Research, the average healthcare EFT claim payment was worth $5,368 in 2025 — $2.94 trillion across 547.66 million payments — against a $2,643 average for the ACH Network as a whole. Healthcare claim payments are 2.03 times the size of a typical ACH item.
That asymmetry is the reason the segment matters more than its transaction count suggests. According to Axis Intelligence Research, healthcare claim payments were 1.56% of ACH Network volume but 3.16% of ACH Network value in 2025. Inside the business-to-business category that contains them, they were 6.78% of payments and 4.66% of dollars, per figures on the Nacha statistics page. They are also, unlike Direct Deposit, a credit-push flow with no consumer-authorization layer, which is why claim payment enrollment friction shows up as an adoption problem rather than a mandate problem.
The average also rose year over year, from an implied $5,198 in 2024. Claim payments are getting larger faster than they are getting more numerous — the same pattern visible across ACH payments as a whole, where value has outgrown volume every quarter of this cycle. Where healthcare differs is that its volume line has flattened while the network’s has not.
What Do the HIPAA Rules Require of Health Plans?
The healthcare EFT standard is not a market preference. It is federal regulation, and the specific citation is worth having.
Under 45 CFR Part 162, HHS adopted the NACHA CCD+ entry with an ASC X12 835 TRN reassociation trace number as the standard for healthcare EFT, effective January 1, 2014, alongside the Phase III CORE EFT and ERA Operating Rule Set. The operative provision for providers is 45 CFR 162.925(a)(1): if a provider asks a health plan to conduct a transaction as a standard transaction, the plan must comply. In practice that means a provider can require ACH payment and the plan cannot refuse.
Virtual credit cards sit outside that framework. CMS Guidance Letter 2022-04 and its accompanying FAQ confirm that HHS’s EFT standards apply only to claim payments made through the ACH Network, that VCC payments fall outside those regulations, and that a plan conditioning standard EFT and ERA delivery on a provider’s acceptance of unwanted payment or reassociation services may be construed as adversely affecting the transaction under 45 CFR 162.925(a)(2). Providers who believe a plan has failed to comply can file through the CMS Administrative Simplification Enforcement Testing Tool.
State law is now moving faster than federal enforcement. California Senate Bill 386, signed October 1, 2025 and effective April 1, 2026, requires dental plans and their contracted vendors to maintain a non-fee-based default payment method and to obtain affirmative consent before putting a provider on a fee-based one, per Nacha’s account of the statute.
Sarah Davis: The federal rule has been sitting there since 2014 and dental adoption is still 33%, which tells you a right you have to assert is not the same as a default you receive. The California approach flips the burden: instead of a dentist filing an enforcement complaint, the plan has to get a signature before it can charge. Watch whether the 2027 CAQH Index shows a California-shaped bump in dental adoption. If it does, that is the enforcement model the rest of the country copies.
Methodology
Collection. Every figure was fetched from a primary source during production on August 24, 2026. Healthcare claim payment volume and value come from Nacha’s ACH Network Volume and Value Statistics page, Nacha’s dated healthcare EFT releases, and Nacha’s 2Q26 ACH Network infographic. Adoption rates and savings estimates come from the 2025 CAQH Index as published by CAQH and reported by Nacha. Payer spending comes from the CMS National Health Expenditure Fact Sheet. Regulatory citations come from the eCFR and from CMS guidance documents. No figure here was taken from an aggregator, a competitor compilation, or model memory.
Calculations. Derived figures were computed in Python from the sourced inputs and are reproducible from the accompanying CSV. Three prose figures are Axis derivations rather than published values: 2022 healthcare claim payment volume of 453.1 million (488.0 ÷ 1.077, from Nacha’s stated 7.7% increase over 2022); 2024 healthcare claim payment value of $2.651 trillion (2.94 ÷ 1.109, from Nacha’s stated 10.9% increase); and second-quarter 2025 volume of 138.2 million (141.4 ÷ 1.023). The third derivation matches a separately reported 138.2 million for that quarter, which is the closest thing to an external check available on this series.
Formulas. EFTS and CPMI components, weights and baselines are disclosed in full in their respective sections. Both are reproducible by a reader working only from the CSV.
What was refused. Two calculations were available and rejected. A 2025 EFTS reading, because CMS has not published 2025 payer spending and mixing vintages across a 7.2% growth year produces a ratio that overstates penetration by nearly eight points. And a single authoritative count of US EFT claim payments, because Nacha’s operator count and the CAQH panel extrapolation differ by an amount neither organization has reconciled.
Scope. Nacha’s healthcare category covers claim payments from insurers to medical and dental providers on the ACH Network; it excludes patient payments to providers, premium payments, and on-us claim payments that never reach an ACH Operator. CAQH adoption rates describe transaction method within its reporting panel, not the national universe. Nacha segment categories overlap and do not sum to network totals.
About This Dataset
The companion CSV contains every figure cited above as an individual row, with value, unit, as-of date, source organization, source document, source URL, retrieval date, primary-source flag, Axis-calculated flag, and a method note on each derived row. It covers ACH healthcare claim payment volume and value from 2014 to 2025, the quarterly series, CAQH adoption and savings figures, CMS payer spending inputs, and both Axis metrics with their components.
Updates are relevance-driven rather than scheduled. The file is revised when Nacha publishes a new quarterly infographic containing the healthcare segment, when CAQH publishes a new Index, or when CMS releases a new National Health Expenditure vintage.
License: CC BY 4.0. Free to use commercially and non-commercially with attribution.
Cite this dataset as: Axis Intelligence Research. Healthcare EFT Statistics 2026. Axis Intelligence, 2026. https://axis-intelligence.com/healthcare-eft-statistics/
Citation
APA Axis Intelligence Research. (2026). Healthcare EFT statistics 2026: 548 million claim payments, $2.94 trillion, and the quarter growth stalled. Axis Intelligence. https://axis-intelligence.com/healthcare-eft-statistics/
MLA Axis Intelligence Research. “Healthcare EFT Statistics 2026: 548 Million Claim Payments, $2.94 Trillion, and the Quarter Growth Stalled.” Axis Intelligence, 24 Aug. 2026, axis-intelligence.com/healthcare-eft-statistics/.
Chicago Axis Intelligence Research. “Healthcare EFT Statistics 2026: 548 Million Claim Payments, $2.94 Trillion, and the Quarter Growth Stalled.” Axis Intelligence. August 24, 2026. https://axis-intelligence.com/healthcare-eft-statistics/.
Frequently Asked Questions
Can a health plan refuse to pay a provider by EFT?
No. Under 45 CFR 162.925(a)(1), if a provider requests that a plan conduct a transaction as a standard transaction, the plan must comply, and the adopted healthcare EFT standard is an ACH CCD+ entry carrying an X12 835 TRN reassociation trace number. The provider must still complete the plan’s EFT enrollment, which the Phase III CORE Operating Rules standardize across plans.
Are virtual credit card claim payments covered by the HIPAA EFT standard?
No. CMS has confirmed that the adopted EFT standards apply only to claim payments made through the ACH Network, and that VCC payments fall outside those regulations and their fee protections. A plan may offer a VCC, but it cannot require one, and conditioning standard EFT and ERA delivery on acceptance of unwanted payment services may violate 45 CFR 162.925(a)(2).
Why do dental practices lag medical practices on EFT adoption?
The 2025 CAQH Index puts dental EFT claim payment adoption at 33% against 78% for medical. The gap reflects payment-method defaults rather than technology access: dental plans have historically defaulted to checks and virtual credit cards, and reversing that default requires per-plan enrollment work that small practices deprioritize. Dental adoption has more than doubled since the 2021 Index.
What is the difference between an EFT and an ERA in claim payment?
The EFT is the money — an ACH credit from the plan to the provider’s bank account. The ERA is the ASC X12 835 remittance advice explaining what the payment covers, line by line. They travel separately, and the TRN reassociation trace number carried in the ACH addenda record is what lets a practice match one to the other. Reassociation failures, not payment failures, are the usual source of posting backlogs.
Is healthcare EFT volume still growing?
Growth has slowed sharply. Full-year 2025 volume rose 7.3%, but second-quarter 2026 volume rose only 2.3% to 141.4 million payments. According to Axis Intelligence Research, the segment added roughly 3.2 million payments year over year in that quarter while the ACH Network overall added about 540 million.
How much of US health insurer spending settles through the ACH Network?
According to Axis Intelligence Research, 71.8% in 2024 — $2.651 trillion in ACH healthcare claim payments against $3.694 trillion in combined private health insurance, Medicare and Medicaid spending reported by CMS. Measured against total national health expenditure of $5.279 trillion, which includes out-of-pocket and administrative spending that never moves as a claim payment, the share is 50.2%.
How much could the industry save by eliminating manual claim payments?
The 2025 CAQH Index puts the remaining opportunity at $21 billion across all manual and partially manual administrative transactions, with $246 million of that attributable specifically to dental practices completing the switch to EFT for claim payments. Those are annual figures based on 2024 activity.
Why do Nacha and CAQH report different EFT claim payment counts?
Because they count different objects. Nacha counts ACH entries actually settled through an ACH Operator; CAQH extrapolates transaction counts from a panel of more than 600 plans and provider organizations covering 63% of insured lives. For 2024 the two produce figures that cannot both describe the same universe, and neither organization has published a reconciliation. Cite one or the other, never a blend.
Does the Same Day ACH dollar limit increase affect claim payments?
It should. The per-payment limit rises from $1 million to $10 million on September 17, 2027, and large institutional claim settlements are among the flows that currently exceed the cap. The relevant number to watch afterward is not healthcare EFT volume but healthcare EFT value per payment, which already averages $5,368.