Sapana Supekar
by on April 12, 2021

Healthcare Claims Management Market Highlights

The healthcare claims management market is expected to demonstrate a CAGR of 5.37% during the forecast period (2018–2023), as per the latest analysis by Market Research Future (MRFR).

Healthcare Claims Management Market Drivers and Top Barriers

Healthcare claims management software is used for managing medical claims as well as reimbursement processes, allowing the healthcare providers to elevate their revenues by efficient claim management. In essence, healthcare claims management refers to a bilateral process between healthcare providers, patients, insurance provider, and the billing company. On account of the quick rate of expansion of the healthcare insurance sector in recent years, the healthcare claims management market is expanding rapidly.

Across the world, the healthcare claims management market is expanding at a significant pace predominantly owing to the burgeoning geriatric population, growing incidences of chronic diseases, elevated focus on healthcare quality services, and the emergence of inventive treatments as well as technologies. The increasing digitization coupled with the booming healthcare information technology (IT) market contributes considerably to the mounting market credentials. The expanding population mandates the need for high quality of coordinated care. The ever-expanding administrative as well as operational expenses in the healthcare industry leads to the need for cost-effective management of claims. As claims management provide practical solutions, compared to the traditional paper-based systems, the demand is set to escalate and influence the market positively in the future.

Some other crucial factors deciding the success rate of the market include the quickly growing healthcare infrastructure along with the increasing uptake of solutions that help manage the rising claims in the healthcare industry. On top of this, the technological advancements brought on by enhanced funding and favorable economic conditions are nurturing the growth of the healthcare claims management market.

Healthcare Claims Management Market Segmentation

The global market for healthcare claims management is segmented on the basis of component, delivery mode type and end-user.

The component-based segments in the market are software and services.

The modes of delivery covered by the report are on-premise and cloud based.

Type-wise, the market is considered for integrated and standalone.

The market, depending on the end-user, has been segmented based on healthcare payers and providers. 

Healthcare Claims Management Market Regional Insight

Asia Pacific, Europe, North America, and the Rest-of-the-World are among the prominent regions where the global healthcare claims management market is set to expand in the near future.

The North America heads the global healthcare claims management market, backed by the sophisticated healthcare industry and favorable government policies. Also, the growing adoption of claim management solutions to avail growth in incentives is expected to stimulate the market growth in the region. In addition to this, the increasing investments within healthcare information technology (HCIT) combined with the presence of regulatory mandates encouraging the use of healthcare claims management solutions also lays a strong foundation for the market. The United States (US) and Canada are among the most profitable countries within the region, successfully implementing healthcare IT, as a result of which the regional market has advanced to considerable heights in recent years. Furthermore, surge in favorable government initiatives, regulatory framework, and innovations in this field have driven the market expansion to a large extent.

Europe has bagged the second position in the global healthcare claims management market, owing to the increase in digitization in conjunction with the rising focus on data integration as well as data governance for the elevated number of claims within the healthcare industry.

The claims management market in Asia Pacific benefits largely by the advancements in technology as well as the healthcare infrastructure. Besides, the mounting adoption rate of claims management systems as a result of the rising number of healthcare facilities within the area has transformed the regional market dynamics. Emerging nations such as India, Japan and China are accountable for the strong adoption of healthcare claims management products and services, contributing immensely to the regional market expansion.

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Healthcare Claims Management Market Top Players

The top vendors within the worldwide healthcare claims management market are IBM Corporation (US), Athenahealth (US), Optum, Inc. (US), Accenture Plc. (Ireland), eClinicalWorks (US), Allscripts Healthcare Solutions, Inc. (US), McKesson Corporation (US), nThrive (US), Oracle Corporation (US), Genpact Limited (US), Infor Inc. (US), Conifer Health Solutions (US), Avaya Inc. (USA), Cerner Corporation (US), Cognizant Technology Solutions Corporation (US), among others.

Latest Update

February 2019

Providence Health & Services (US) has acquired Lumedic Inc. (US), which provides platform for revenue cycle management on the basis of machine learning, patient-centric design and blockchain for claims processing.

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