Healthcare Claims Management Market - Global Outlook & Forecast 2022-2027

In-depth Analysis and Data-driven Insights on the Impact of COVID-19 Included in this Global Healthcare Claims Management Market Report

The healthcare claims management market by revenue is expected to grow at a CAGR of 4.79% during the period 2022–2027.

THE HEALTHCARE CLAIMS MANAGEMENT MARKET INSIGHTS

  • Artificial Intelligence (AI) has transformed various industries across the globe and radically can alter the healthcare field. With growing advancements in the healthcare industry, AI has become an efficient, faster, and inexpensive choice for healthcare claims management.
  • Medical claims management is the organization, billing, filing, updating, and processing of medical claims related to diagnoses, treatment, and medication of patients. Medical billing is one of the areas in which healthcare uses automation to a large extent.
  • Medical billing is one of the significant parameters in healthcare revenue cycle management. The medical billing and their respective coding help establish and categorize patient information that dictates the billing of Medicare and insurance companies.
The following factors are likely to contribute to the growth of the Healthcare Claims Management market during the forecast period:
  • AI-powered Smart Healthcare Claims Management
  • Advancement of Automated Medical Billing and Management
  • Upsurge in Private Health Insurance
  • Growing Importance of Denials Management
  • Linking Electronic Health Records & E-Prescription with Claims Management
  • Growing Adoption of Cloud-based Solutions
The report considers the present scenario of the global healthcare claims management market and its market dynamics for the period 2022−2027. It covers a detailed overview of several market growth enablers, restraints, and trends. The study covers both the demand and supply side of the market. It also profiles and analyses leading companies and several other prominent companies operating in the market.

THE HEALTHCARE CLAIMS MANAGEMENT MARKET SEGMENTATION

This research report includes a detailed segmentation by
  • Component
  • Type
  • Delivery mode
  • End-users
  • Geography
SEGMENTATION ANALYSIS
  • A good medical claims management system must service existing products with added built-in flexibility for supporting products with new and unique features, including outpatient coverage or products with a savings component.
  • The growing demand for claims management processing services is majorly from physicians and other healthcare providers. With the rise in physician visits, the number of medical claims increases, thereby, creating demand for the industry.
Market Segmentation by Component
  • Software
  • Services
Market Segmentation by Type
  • Integrated
  • Standalone
Market Segmentation by Delivery mode
  • Web and cloud-based
  • On-premises
Market Segmentation by End User
  • Healthcare payers
  • Healthcare providers
GEOGRAPHICAL ANALYSIS
  • North America dominates the global healthcare claims management market with a rise in the number of patients with medical insurance, rise in patient volume, adoption of EHRs and e-prescribing services, the rising importance of denials management, increase in medical billing errors, rising government investments, and advancing healthcare infrastructure in the region.
  • APAC is anticipated to be the fastest-growing region in the global healthcare claims management market with growing awareness for medical claims and the rising cost of medical treatments.
Market Segmentation by Geography
  • North America
US

Canada
  • Europe
Germany

UK

France

Italy

Spain
  • APAC
China

India

Japan

Australia

South Korea
  • Latin America
Brazil

Mexico

Argentina
  • Middle East and Africa
South Africa

Turkey

Saudi Arabia

VENDOR ANALYSIS
  • Cerner acquired AbleVets LLC, a health IT engineering and consulting company specializing in cybersecurity, cloud, and system development solutions for federal organizations, to enhance resource capabilities and growth opportunities within its federal business.
  • eClinicalWorks announced a collaboration with Humana, a leading health and well-being company; GuideWell, the parent to a family of forward-thinking companies focused on transforming healthcare.
Prominent Vendors
  • Cerner
  • McKesson Corporation
  • UnitedHealth Group
  • eClinicalWorks
  • Cegedim
Other Prominent Vendors
  • Advanced Billing
  • AdvancedMD
  • Allscripts Healthcare
  • Athenahealth
  • Availity
  • Bizmatics
  • Brightree
  • CareCloud
  • Clearwave
  • Cognizant
  • Comindware
  • Conduent
  • Conifer Health Solutions
  • DataGenix
  • eMD technologies
  • Epic Systems Corporation
  • Experian Information Solutions
  • Flatworld Solutions
  • GeBBS Healthcare Solutions
  • Genpact
  • Global Excel Management
  • Healix
  • IBM
  • Kareo
  • Majesco
  • Manorama Infosolutions
  • Milliman
  • Modernizing Medicine
  • Nextech Systems
  • NXGN Management
  • nThrive Revenue Systems
  • Damar Software
  • Oracle
  • OSP Labs
  • PayerFusion Holdings
  • Pegasystems
  • PLEXIS Healthcare Systems
  • Proclaim
  • Pulse Systems
  • SS&C Technologies
  • Quest Diagnostics
  • RAM Technologies
  • RXNT
  • SequelMed
  • SSI Group
  • TotalMD
  • Waystar
KEY QUESTIONS ANSWERED:

1. How big is the healthcare claims management market?

2. What is the growth rate of the healthcare claims management market?

3. What are the factors driving the healthcare claims management market?

4. Who are the key players in the healthcare claims management market?

5. Which region accounted for the largest healthcare claims management market share?


1 Research Methodology
2 Research Objectives
3 Research Process
4 Scope & Coverage
4.1 Market Definition
4.1.1 Inclusions
4.1.2 Exclusions
4.1.3 Market Estimation Caveats
4.2 Base Year
4.3 Scope Of The Study
4.3.1 Market Segmentation By Component
4.3.2 Market Segmentation By Type
4.3.3 Market Segmentation By Delivery Mode
4.3.4 Market Segmentation By End User
4.3.5 Market Segmentation By Geography
5 Report Assumptions & Caveats
5.1 Key Caveats
5.2 Currency Conversion
5.3 Market Derivation
6 Market at a Glance
7 Introduction
7.1 Overview
8 Market Opportunities & Trends
8.1 Ai-Powered Smart Healthcare Claims Management
8.2 Advances In Automated Medical Billing & Claims Management
8.3 Upsurge In Private Health Insurance
9 Market Growth Enablers
9.1 Growing Importance Of Denials Management
9.2 Linking EHR & E-Prescription With Claims Management
9.3 Rising Adoption Of Cloud-Based Solutions
10 Market Restraints
10.1 Security Concerns & Data Privacy Issues
10.2 High Cost Of Claims Processing & Lack Of Skilled Professionals
10.3 Risk Of Errors & Fraud In Claims Management
11 Market Landscape
11.1 Market Overview
11.2 Market Size & Forecast
11.2.1 Geographic Analysis
11.2.2 Component Analysis
11.2.3 Claim Type Analysis
11.2.4 Delivery Mode Analysis
11.3 Five Forces Analysis
11.3.1 Threat Of New Entrants
11.3.2 Bargaining Power Of Suppliers
11.3.3 Bargaining Power Of Buyers
11.3.4 Threat Of Substitutes
11.3.5 Competitive Rivalry
12 Component
12.1 Market Snapshot & Growth Engine
12.2 Market Overview
12.3 Software
12.3.1 Market Overview
12.3.2 Market Size & Forecast
12.3.3 Software: Geography Segmentation
12.4 Services
12.4.1 Market Overview
12.4.2 Market Size & Forecast
12.4.3 Services: Geography Segmentation
13 Claim Type
13.1 Market Snapshot & Growth Engine
13.2 Market Overview
13.3 Integrated
13.3.1 Market Overview
13.3.2 Market Size & Forecast
13.3.3 Integrated: Geography Segmentation
13.4 Standalone
13.4.1 Market Overview
13.4.2 Market Size & Forecast
13.4.3 Standalone: Geography Segmentation
14 Delivery Mode
14.1 Market Snapshot & Growth Engine
14.2 Market Overview
14.3 Web & Cloud-Based
14.3.1 Market Overview
14.3.2 Market Size & Forecast
14.3.3 Web & Cloud-Based: Geography Segmentation
14.4 On-Premise
14.4.1 Market Overview
14.4.2 Market Size & Forecast
14.4.3 On-Premise: Geography Segmentation
15 End User
15.1 Market Snapshot & Growth Engine
15.2 Market Overview
15.3 Healthcare Providers
15.3.1 Market Overview
15.3.2 Market Size & Forecast
15.3.3 Healthcare Providers: Geography Segmentation
15.4 Healthcare Payers
15.4.1 Market Overview
15.4.2 Market Size & Forecast
15.4.3 Healthcare Payers: Geography Segmentation
16 Geography
16.1 Market Snapshot & Growth Engine
16.2 Geographic Overview
17 North America
17.1 Market Overview
17.2 Market Size & Forecast
17.2.1 North America: Component Segmentation
17.2.2 North America: Type Segmentation
17.2.3 North America: Delivery Mode Segmentation
17.2.4 North America: End-User Segmentation
17.3 Key Countries
17.3.1 US: Market Size & Forecast
17.3.2 Canada: Market Size & Forecast
18 Europe
18.1 Market Overview
18.2 Market Size & Forecast
18.2.1 Europe: Component Segmentation
18.2.2 Europe: Type Segmentation
18.2.3 Europe: Delivery Mode Segmentation
18.2.4 Europe: End-User Segmentation
18.3 Key Countries
18.3.1 Germany: Market Size & Forecast
18.3.2 UK: Market Size & Forecast
18.3.3 France: Market Size & Forecast
18.3.4 Italy: Market Size & Forecast
18.3.5 Spain: Market Size & Forecast
19 APAC
19.1 Market Overview
19.2 Market Size & Forecast
19.2.1 APAC: Component Segmentation
19.2.2 APAC: Type Segmentation
19.2.3 APAC: Delivery Mode Segmentation
19.2.4 APAC: End-User Segmentation
19.3 Key Countries
19.3.1 China: Market Size & Forecast
19.3.2 Japan: Market Size & Forecast
19.3.3 India: Market Size & Forecast
19.3.4 South Korea: Market Size & Forecast
19.3.5 Australia: Market Size & Forecast
20 Latin America
20.1 Market Overview
20.2 Market Size & Forecast
20.2.1 Latin America: Component Segmentation
20.2.2 Latin America: Type Segmentation
20.2.3 Latin America: Delivery Mode Segmentation
20.2.4 Latin America: End-User Segmentation
20.3 Key Countries
20.3.1 Brazil: Market Size & Forecast
20.3.2 Mexico: Market Size & Forecast
20.3.3 Argentina: Market Size & Forecast
21 Middle East & Africa
21.1 Market Overview
21.2 Market Size & Forecast
21.2.1 Middle East & Africa: Component Segmentation
21.2.2 Middle East & Africa: Type Segmentation
21.2.3 Middle East & Africa: Delivery Mode Segmentation
21.2.4 Middle East & Africa: End-User Segmentation
21.3 Key Countries
21.3.1 Turkey: Market Size & Forecast
21.3.2 South Africa: Market Size & Forecast
21.3.3 Saudi Arabia: Market Size & Forecast
22 Competitive Landscape
22.1 Competition Overview
22.2 Market Share Analysis
22.2.1 Cerner In Healthcare Claims Management Market
22.2.2 Mckesson In Healthcare Claims Management Market
22.2.3 Optum In Healthcare Claims Management Market
22.2.4 Eclinicalworks In Healthcare Claims Management Market
22.2.5 Cegedim In Healthcare Claims Management Market
23 Key Company Profiles
23.1 CERNER
23.1.1 Business Overview
23.1.2 Cerner In Healthcare Claims Management Market
23.1.3 Product Offerings
23.1.4 Key Strategies
23.1.5 Key Strengths
23.1.6 Key Opportunities
23.2 MCKESSON
23.2.1 Business Overview
23.2.2 Mckesson In Healthcare Claims Management Market
23.2.3 Product Offerings
23.2.4 Key Strategies
23.2.5 Key Strengths
23.2.6 Key Opportunities
23.3 UNITEDHEALTH GROUP
23.3.1 Business Overview
23.3.2 Optum In Healthcare Claims Management Market
23.3.3 Product Offerings
23.3.4 Key Strategies
23.3.5 Key Strengths
23.3.6 Key Opportunities
23.4 ECLINICALWORKS
23.4.1 Business Overview
23.4.2 Eclinicalworks In Healthcare Claims Management Market
23.4.3 Product Offerings
23.4.4 Key Strategies
23.4.5 Key Strengths
23.4.6 Key Opportunities
23.5 CEGEDIM
23.5.1 Business Overview
23.5.2 Cegedim In Healthcare Claims Management Market
23.5.3 Product Offerings
23.5.4 Key Strategies
23.5.5 Key Strengths
23.5.6 Key Opportunities
24 Other Prominent Vendors
24.1 ADVANCED BILLING
24.1.1 Business Overview
24.1.2 Product Offerings
24.2 ADVANCEDMD
24.2.1 Business Overview
24.2.2 Product Offerings
24.3 ALLSCRIPTS HEALTHCARE
24.3.1 Business Overview
24.3.2 Product Offerings
24.4 ATHENAHEALTH
24.4.1 Business Overview
24.4.2 Product Offerings
24.5 AVAILITY
24.5.1 Business Overview
24.5.2 Product Offerings
24.6 BIZMATICS
24.6.1 Business Overview
24.6.2 Product Offerings
24.7 BRIGHTREE
24.7.1 Business Overview
24.7.2 Product Offerings
24.8 CARECLOUD
24.8.1 Business Overview
24.8.2 Product Offerings
24.9 CLEARWAVE
24.9.1 Business Overview
24.9.2 Product Offerings
24.10 COGNIZANT
24.10.1 Business Overview
24.10.2 Product Offerings
24.11 COMINDWARE
24.11.1 Business Overview
24.11.2 Product Offerings
24.12 CONDUENT
24.12.1 Business Overview
24.12.2 Product Offerings
24.13 CONIFER HEALTH SOLUTIONS
24.13.1 Business Overview
24.13.2 Product Offerings
24.14 DATAGENIX
24.14.1 Business Overview
24.14.2 Product Offerings
24.15 EMD TECHNOLOGIES
24.15.1 Business Overview
24.15.2 Product Offerings
24.16 EPIC SYSTEMS
24.16.1 Business Overview
24.16.2 Product Offerings
24.17 EXPERIAN INFORMATION SOLUTIONS
24.17.1 Business Overview
24.17.2 Product Offerings
24.18 FLATWORLD SOLUTIONS
24.18.1 Business Overview
24.18.2 Product Offerings
24.19 GEBBS HEALTHCARE SOLUTIONS
24.19.1 Business Overview
24.19.2 Product Offerings
24.20 GENPACT
24.20.1 Business Overview
24.20.2 Product Offerings
24.21 GLOBAL EXCEL MANAGEMENT
24.21.1 Business Overview
24.21.2 Product Offerings
24.22 HEALIX
24.22.1 Business Overview
24.22.2 Product Offerings
24.23 IBM
24.23.1 Business Overview
24.23.2 Product Offerings
24.24 KAREO
24.24.1 Business Overview
24.24.2 Product Offerings
24.25 MAJESCO
24.25.1 Business Overview
24.25.2 Product Offerings
24.26 MANORAMA INFOSOLUTIONS
24.26.1 Business Overview
24.26.2 Product Offerings
24.27 MILLIMAN
24.27.1 Business Overview
24.27.2 Product Offerings
24.28 MODERNIZING MEDICINE
24.28.1 Business Overview
24.28.2 Product Offerings
24.29 NEXTECH SYSTEMS
24.29.1 Business Overview
24.29.2 Product Offerings
24.30 NXGN MANAGEMENT
24.30.1 Business Overview
24.30.2 Product Offerings
24.31 NTHRIVE REVENUE SYSTEMS
24.31.1 Business Overview
24.31.2 Product Offerings
24.32 DAMAR SOFTWARE
24.32.1 Business Overview
24.32.2 Product Offerings
24.33 ORACLE
24.33.1 Business Overview
24.33.2 Product Offerings
24.34 OSP LABS
24.34.1 Business Overview
24.34.2 Product Offerings
24.35 PAYERFUSION HOLDINGS
24.35.1 Business Overview
24.35.2 Product Offerings
24.36 PEGASYSTEMS
24.36.1 Business Overview
24.36.2 Product Offerings
24.37 PLEXIS HEALTHCARE SYSTEMS
24.37.1 Business Overview
24.37.2 Product Offerings
24.38 PROCLAIM
24.38.1 Business Overview
24.38.2 Product Offerings
24.39 PULSE SYSTEMS
24.39.1 Business Overview
24.39.2 Product Offerings
24.40 SS&C TECHNOLOGIES
24.40.1 Business Overview
24.40.2 Product Offerings
24.41 QUEST DIAGNOSTICS
24.41.1 Business Overview
24.41.2 Product Offerings
24.42 RAM TECHNOLOGIES
24.42.1 Business Overview
24.42.2 Product Offerings
24.43 RNXT
24.43.1 Business Overview
24.43.2 Product Offerings
24.44 SEQUELMED
24.44.1 Business Overview
24.44.2 Product Offerings
24.45 SSI GROUP
24.45.1 Business Overview
24.45.2 Product Offerings
24.46 TOTALMD
24.46.1 Business Overview
24.46.2 Product Offerings
24.47 WAYSTAR
24.47.1 Business Overview
24.47.2 Product Offerings
25 Report Summary
25.1 Key Takeaways
25.2 Strategic Recommendations
26 Quantitative Summary
26.1 Market By Component
26.1.1 North America: Component Segmentation
26.1.2 Europe: Component Segmentation
26.1.3 APAC: Component Segmentation
26.1.4 Latin America: Component Segmentation
26.1.5 Middle East & Africa: Component Segmentation
26.2 Market By Claim Type
26.2.1 North America: Type Segmentation
26.2.2 Europe: Type Segmentation
26.2.3 APAC: Type Segmentation
26.2.4 Latin America: Type Segmentation
26.2.5 Middle East & Africa: Type Segmentation
26.3 Market By Delivery Mode
26.3.1 North America: Delivery Mode Segmentation
26.3.2 Europe: Delivery Mode Segmentation
26.3.3 APAC: Delivery Mode Segmentation
26.3.4 Latin America: Delivery Mode Segmentation
26.3.5 Middle East & Africa: Delivery Mode Segmentation
26.4 Market By End User
26.4.1 North America: End-User Segmentation
26.4.2 Europe: End-User Segmentation
26.4.3 APAC: End-User Segmentation
26.4.4 Latin America: End-User Segmentation
26.4.5 Middle East & Africa: End-User Segmentation
26.5 Market By Geography
26.5.1 Software: Geography Segmentation
26.5.2 Services: Geography Segmentation
26.5.3 Integrated: Geography Segmentation
26.5.4 Standalone: Geography Segmentation
26.5.5 Web & Cloud Based: Geography Segmentation
26.5.6 On-Premise: Geography Segmentation
26.5.7 Healthcare Providers: Geography Segmentation
26.5.8 Healthcare Payers: Geography Segmentation
27 Appendix
27.1 Abbreviations

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